Neurostimulation is a tried and tested method of managing pain but one that is not being used to its full benefits, according to experts in the field. As Lyme disease can result in nerve damage and chronic pain in some people it is possible that improving physicians’ knowledge of neurostimulation devices could lead to increased treatment options for those left with permanent pain after Lyme disease infection is successfully eradicated.
A meeting of the International Neuromodulation Society, coinvolgendo 60 neurostimulation experts from around the world, was convened this year with the purpose of assessing current literature on neurostimulation for pain management and to create an expert opinion on appropriate use of this intervention. The result was four articles published in the August, 2014, edition of Neuromodulation, which deal with appropriate use of neurostimulation of the spinal cord and peripheral nervous system and of the intracranial and extracranial space and head. The articles also discuss best practices to avoid and treat complications of neurostimulation, and emerging neurostimulation therapies.
Neuropathic pain, such as can be caused following nervous system infection of pronounced tissue damage in Lyme disease, may be treated using implantable technologies such as traditional dorsal column stimulation or spinal cord stimulation (SCS), peripheral nerve stimulation (PNS), peripheral nerve field stimulation, deep brain stimulation (DBS), and motor cortex stimulation.
What is Neurostimulation?
These stimulation systems usually have an impulse generator, electrical leads, and a controller that the patient uses to manage the impulses. Use of such devices can be life-changing, especially for patients who have long given up on ever being free of pain or being able to dramatically improve quality of life after nerve damage.
Improved technology has made appropriate neurostimulation a safe and effective option for managing many chronic pain conditions and since spinal cord stimulation was first introduced in 1967 it has become well accepted as a treatment for chronic pain. Typical uses of SCS include failed back surgery syndrome, complex regional pain syndrome, and radiculopathy.
SCS has also been used for nerve pain resulting from trauma, for diabetic neuropathy, and for postherpetic neuralgia, suggesting that it may be useful in other conditions where nerve damage has occurred, such as in some cases of Lyme disease. This is especially true as technological advances now allow the dorsal root ganglion to be a target for SCS, expanding the potential use of neurostimulation to others with chronic pain.
One of the benefits of neurostimulation is its capacity to help patients reduce reliance on pain medications, thereby lessening the risk of side effects of these medications, many of which may be prescribed for several decades of a patient’s life.
Trigeminal Neuralgia and Lyme Disease
Knowledge of Deep Brain Stimulation (DBS) is also increasingly rapidly but researchers continue to investigate targets outside of the brain in order to reduce the risks of neurostimulation. DBS is not considered appropriate for treating conditions such as facial pain caused by trigeminal neuralgia, which can result from Lyme disease, but peripheral nerve stimulation (PNS) has been seen to be successful in treating migraine and other headache disorders and facial pain even though the devices used were not designed for treating the head or neck.
The researchers convening at the meeting agreed that PNS treatment of the extracranial nerves was to be recommended for pain before people are prescribed long-term, long-acting opioids for pain management. This would help reduce opioid addiction and the risk of opioid associated deaths (which have risen alarmingly in recent years in the US).
PNS has been seen to be helpful in treating chronic migraine, another possible lasting effect of Lyme disease. Neurostimulation is certainly not being recommended for treating all cases of migraine, just for those that have not responded to regular treatment and which are severe and disabling. Such treatment can make a huge difference for people whose quality of life is significantly diminished because of pain.
Risks of Neurostimulation
Major problems faced in the field of neurostimulation include issues with hardware failure, especially the electronic leads for these devices, and the potential for infection and neurologic damage. Epidural hematoma can be a complication of implanted devices, but this is exceedingly rare. Technological advances have now reduced problems associated with leads becoming detached and migrating.
The expert panel also recommended that anyone implanting neurostimulation devices have hospital-admission privileges, perform at least 10 supervised implantations during training, monitor their outcomes and quality indicators, and perform a high volume of implant procedures to keep their skills up-to-date. This would avoid many of the issues that have arisen likely in connection with the inexperience of the physician implanting these devices. For one thing, having these implantation procedures performed in hospital, rather than in a doctor’s office, would make it significantly more likely that the operation is done under sterile conditions, so as to reduce the risk of infection.
Anyone with long-lasting neurological symptoms of Lyme disease is advised to discuss the potential benefits of neurostimulation with their physician and to get a referral to a specialist, especially in cases of trigeminal nerve damage or chronic pain associated with Lyme disease.
The Appropriate Use of Neurostimulation of the Spinal Cord and Peripheral Nervous System for the Treatment of Chronic Pain and Ischemic Diseases: The Neuromodulation Appropriateness Consensus Committee. Neuromodulation. 2014;17:513-617.