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Home > Post-Herpetic Neuropathy – Intensive Treatments – Part IV

Post-Herpetic Neuropathy – Intensive Treatments – Part IV

Jenny AndrusJenny L. F. Andrus, MD

For patients who suffer with severe post-herpetic neuropathy and neuralgia who are debilitated by chronic pain may benefit from more intensive therapies, such as electronic cell signaling therapy (ECST), peripheral nerve stimulation (PNS) or Electronic Spinal Cord Stimulation (ESCS). In this final segment of this four-part series, I’ll discuss these therapies and how each can address the symptoms of PHN.

Electronic cell signaling therapy (ECST) is one of the newer and more controversial forms of treatment for PHN, as it has not been approved for payment by most insurance companies.  It has, however, been cleared by the FDA for a variety of neuropathic conditions and has shown promise in providing relief to patients that suffer with PHN. It has shown measurable results in increasing nerve fibers in patients using pre and post treatment biopsies of their dermal layers. Some patients report significant pain relief from PHN after completing a course of ECST treatments. This is the only treatment of the three we will discuss today that MAY have some regenerative capabilities to help damaged nerves, but more research is needed to prove this.

This treatment uses the application of electrodes that supply varying wavelengths of electric current to stimulate circulation and the regeneration of nerve fibers in the skin in patients who suffer with peripheral neuropathy, polyneuropathies, and forms of PHN.   Treatment typically takes around 20-30 sessions of 20-30 minutes each, however, if the patient doesn’t see a noticeable difference in around seven sessions, they are encouraged to discontinue treatment.

Peripheral nerve stimulation (PNS) is another form of implantable neuromodulation that seeks to override the pain signals that are being sent to the brain with another more pleasant sensation.  How this neuromodulation differs from ESCS is that this implantation is not done in the spinal cord area but done near the painful nerve itself.  So, whether the patient has a painful knee two years after a successful knee replacement surgery, if they have peripheral neuropathy in their toes or if they have a painful shoulder, they can have the nerve stimulator placed where the painful nerve resides.

The patient can try this form of neuromodulation before having the lead permanently implanted to see if it provides significant pain relief.  A benefit of this type of nerve stimulation is that the patient doesn’t have to have the battery implanted within the body but can wear it outside the body on a belt.   The patient who has this stimulator permanently implanted will be able to turn it on and off at will, adjust the settings, intensity and use all the various frequencies that are now being included for pain relief, as all people are different in what they prefer.

Electronic Spinal Cord Stimulation (ESCS) is the form of neuromodulation where a lead is placed near the spinal cord to deliver pleasant electrical stimuli to the brain to overwhelm or distract the brain from pain signals.  Depending upon where the patient feels pain in the body, the lead is placed correspondingly in the spinal column where the nerve roots provide sensation for that body part.

A trial for pain relief efficacy is always utilized for the ESCS as it is the most expensive and more invasive option of the three, we’ve discussed.  We typically look for at least a 50% reduction in pain and/or a significant reduction in the dosage of pain medication required daily as a reliable indicator that the trial was a success.  During the trial, the patient will be encouraged to turn the stimulator on and off, the intensity up and down and try the various modes and frequencies available.  In the past, these stimulators were not MR scanner compatible, but now most are becoming so.

The permanent implantation of an electronic spinal cord stimulator is an outpatient procedure that will be performed by one of our fellowship-trained spine surgeons because it requires careful placement and suturing in place near the spinal cord.  Recovery from this ambulatory surgery can take several weeks as the ligaments heal from being removed from the spinal bones to allow the surgeon to place the lead permanently.

As a interventional pain physician, I have seen remarkable results from the use of ESCS in patients with chronic PHN and they have been given a great quality of life.  However, it is not for everyone and these treatment options should be carefully discussed with your physician before making any decision.

 

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