Neurostimulation: Inceptiv™ fighting chronic neuropathic pain

Neurostimulators play an important role in the treatment of chronic pain conditions. They use targeted electrical impulses to modulate pain signals. The Inceptiv™ neurostimulator from Medtronic is an example of a treatment solution for chronic neuropathic pain. It can offer sufferers a significant improvement in their quality of life.

Neurostimulators use electrical impulses to stimulate specific nerves in the body. They are often used to treat neurological diseases such as Parkinson's, epilepsy or chronic pain by modulating the electrical activity of the nervous system.

The neurostimulator is implanted for this purpose, which is usually done surgically and requires precise placement of the device. Programmable settings are necessary to address the individual needs of the person affected.

The decision to implant a neurostimulator is based on strict medical criteria. "These are patients for whom surgical treatment of the problem and the cause of the pain is no longer possible or feasible. These include, for example, people who have developed neuropathic pain syndrome following a slipped disc," explains Prof. Malgorzata Kolodziej, Head of Pain Therapy and Neuromodulation at University Clinic Hospital Giessen and Marburg (UKGM).

Neurostimulation is not only suitable for patients with neuropathic pain. Patients with circulatory disorders such as peripheral arterial occlusive disease (PAD) or phantom pain also benefit from this form of pain therapy.

Diagnosis and selection are based on precise diagnostic procedures and comprehensive consultations to ensure that the neurostimulator can be used effectively and safely.

The process surrounding the use of the neurostimulator is carried out in close collaboration between neurosurgeons, pain therapists and other specialists. "Interdisciplinary treatment is the key to successful therapy," emphasizes Prof. Kolodziej. This cooperation makes it possible to tailor the therapy to the individual needs of those affected.

When implanting the neurostimulator for pain therapy, the target nerves are first precisely localized using imaging techniques such as MRI or CT. The surgeon then places the electrodes along the affected nerve pathways. A kind of pocket is then created under the skin to implant the neurostimulator. After placement, the electrodes are connected to the stimulator, which can be individually adjusted via an external control unit to achieve optimal pain relief for those affected.

The Inceptiv™ neurostimulator was implanted in November 2023 at the UKGM by Prof. Kolodziej as one of the first in Europe and is currently only approved in the EU and Japan. Since then, five further implantations of the latest generation of neurostimulators have followed at the UKGM (as of February 2024), which for the first time can adapt their effectiveness in real time to the movements and activities of the person affected. This helps to minimize the risk of under- or overdosing.

The neurostimulator uses closed-loop technology, which makes it possible to automatically adjust the stimulation based on feedback from the patient's spinal cord. Such technical innovations help to make the therapy less dependent on manual adjustments and ensure constant pain relief.

The integration of new technologies such as the Inceptiv™ neurostimulator into pain therapy not only offers improved treatment options, but also hope for patients who have not yet experienced any relief from their pain.

Further development of the technology so that the frequency of the electrical impulses can be automatically adjusted should be a goal for the future, according to Prof. Kolodziej. Until now, doctors have had to decide whether high-frequency or low-frequency stimulation should be used. The automatic and individual adjustment of the frequency would allow the neurostimulator to adapt the optimal frequency based on the needs of the patient, which would lead to more precise and individualized pain relief.