Occipital neuromodulation uses the same technology as spinal cord stimulation, which has been around for forty years. How does it work? Well, it turns out that within the brain, there are parts responsible for making people aware of pain. When people have chronic pain lasting over a year, there are often changes in those parts of the brain that promote the sensation of pain, even when the original cause for the pain is gone and healing has occurred. When people say, “The pain is in your head,” they are sometimes right!
The occipital nerves are rather special nerves because they are connected quite directly to the brain itself. They can be found under the skin of the back of the head (the occipital region). For over ten years, specialists in pain management have found that by stimulating these nerves with tiny electrical currents they could relieve migraine pain. Along with a handful of other pain specialists in the United States, we at PainCare have been using a similar technique which helps not only patients with migraines, but also those with fibromyalgia, depression, traumatic brain injury, and those with chronic pain from damage or diseases of the nervous system. Many of my patients have had pain for thirty years or longer. They have seen many doctors over the years who have not been able to help them. They have been told by their doctors, “There is nothing else that can be done. You will have to learn to live with your pain.” These same patients who were once depressed over being told this are now enjoying the kind of pain relief they have dreamed of for all these years. They are reclaiming their lives and are returning to “their former selves” before the pain smothered them.
Two stages of treatment
There are two stages to the procedure. The first is called the trial phase. The trial phase involves temporarily placing two electrodes under the skin in the occipital region. There is no cutting of the skin and the electrodes sit just under the surface. They do not travel even close to the brain. The procedure itself takes 5-10 minutes to perform under local anesthesia. Patients go home shortly thereafter. Patients are allowed to keep the electrodes under the skin for one month and then they are removed in the office. When the electrodes are removed, this ends the first stage. The analogy is that of “taking a test drive of a car you’re thinking of buying. In this case, you get to take the car home for a month and see how you like it before deciding whether to buy it.”
The second stage is an implant procedure. If the patient reports good relief from their pain, a meeting is scheduled with a peripheral nerve surgeon to arrange for the implantation of the electrodes under the skin. The difference here is that the electrodes and battery are placed under the skin much like a cardiac pacemaker, but for pain. Because everything is implanted, patients can perform any vigorous activity, including swimming, lifting weights, and running. It does take surgery to do this, but the patients are asleep during the surgery and they go home the same day.
An attractive feature of the implanted system is that it is only skin deep. If the pain goes away or is otherwise cured sometime in the future, the system can be easily removed.
Should you trial occipital neuromodulation?
To see if you are a candidate for occipital neuromodulation, schedule a consultation to review your medical records and diagnostic studies, take your history, and do an examination. If you are an appropriate candidate for the procedure, you will be so informed right then and there.