David Schultz, M.D.
In the 20th century, doctors destroyed nerves believing it would relieve pain. In the 21st century, doctors understand destroying nervous system components often makes pain worse.
But with the advance of medical technology, modern pain physicians have turned to neuromodulation rather than nerve destruction — that is, changing how the nervous system processes pain by delivering electricity or medication to nerve roots, or even directly to the spinal cord.
Two types of neuromodulation
Neurostimulation blocks pain by delivering low-voltage electrical signals to the peripheral or central nervous system. Targeted drug delivery delivers small quantities of pain-relieving medications directly to the spinal cord.
Both techniques block pain at the spinal level, keeping the brain free from the mental side effects of pills and patches. Both are done on a trial basis before implant of a permanent (yet reversible) pain control system, and both allow the pain physician to eliminate or reduce opioids to the lowest possible dose.
Given the opioid crisis, more and more practitioners are reluctant to prescribe opioids, instead referring their most challenging patients to pain specialists for 21st century solutions.