Relief Through - The Peripheral Nerve Stimulation PNS
We all know the situation when we bang our head on the edge of the door or cut a finger peeling potatoes, the signal “pain” draws our attention to the injured area of our body. We can then treat the cause of the pain and the pain signal goes away of its own accord, usually within a short space of time. But what happens if the pain persists of its own accord and will not go away?

The Hamburg surgeon Omar Omar-Pasha adds, "Especially with patients with back pain. For example, after a disc operation a pain signal still exists even though perhaps the actual cause has long been removed. Normal medicaments are of little help. In the end the only thing to do in most cases is to resort to a high dosage of pain reliever.” Pain „pacemaker“ helps with electrical pulses  In many cases there is help at hand with the implantation of a so-called pain “pacemaker” (SCS). This uses an electrode placed near the spinal cord. It gives weak electrical pulses, which serve more or less as a jamming transmitter, which targets the nerve’s message signal channels.

The way it works is similar to when one rubs a sore part of the body after it has been knocked. By rubbing the injured point the feeling of pain is relieved. This is just how the spinal chord stimulator works with the electrical impulses in the background.

Equally successful with peripheral nerves: It is not only the spinal chord nerves, which can be stimulated in this manner. Pain from peripheral nerves, for example, in the elbow can be similarly treated. The electrode can be sewn directly onto the nerve sheath in a minor operation. In this way it will be secure and will not be displaced during normal movements. Omar-Pasha explains: “The impulse transmitter for the electrode will be implanted under the skin. The electrode is controlled by a small unit about the size of a box of matches. The length and intensity of the pulses can be individually controlled by the user to suit each situation.”

„“The impulse sender for the electrode is implanted under the skin so it will not be noticed by anyone.” explains the Hamburg surgeon Omar-Pasha. A test phase is necessary before implantation. The implantation of a nerve stimulator takes place in two stages. Omar-Pasha comments: “First the electrode is placed in the general area of pain under local anaesthetic, then stimulation tests are made to decide where the best place is. With the help of the patient the optimal setting of impulse strength and frequency are chosen. After the operation the patient can return home and monitor whether there has been any noticeable alleviation of pain. After a few days the doctor and patient will decide together whether the system should be fitted permanently."

Spinal and peripheral nerve stimulation means that one is in a position to considerably reduce the amount of medication needed. Another method for patients deemed to be beyond treatment which can have good success is the administration of morphium using a medicament pump. This uses a tiny catheter to deliver an adjustable quantity of morphium directly into the cerebal spinal chord fluid using a computer controlled pump. As with a pain pacemaker, the pump will be implanted in the abdominal wall and the settings can be made by a doctor.

Its advantage over oral or intravenous application of pain reliever is that the dosage, and hence the active agent, can be finely and consistently applied to precisely where it is needed. In most cases, patients with a morphium pump require a smaller dosage than when given by other means.
“Many people can return to a normal life after a long phase of living in seclusion. And it is even not unusual for them to return to work,”
comments Omar-Pasha. Peripheral nerve stimulation is an effective method for making chronic nerve pain bearable for patients. In Germany there are some ten practitioners who can carry out this operation.

The Hamburg surgeon Omar Omar-Pasha lists what the requirements are to get this treatment :

  • A causal therapy is no longer possible
  • Conventional therapy has failed
  • There is no psychological illness present

“It is important”, the Hamburg surgeon states, “that today, no one should live in dreadful pain any more. Whereas in the past a patient had to accept the oft spoken phrase, ‘you must live with it’, with little hope of recovery, today, we are in a position with the use of spinal or peripheral nerve stimulation and the precision injection of pain reliever from medicament pumps, to reduce the amounts of medication needed and to clearly improve the quality of life of many patients.” Most health insurance providers will pay for the cost of an electrical nerve stimulator or morphium pump once it is shown to be necessary because other methods are of no help.

Source: Orthopress, year 5, issue 3/ 02 pages 62 - 63

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