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Neuromodulation & Implantable Pain Therapy

Expert Pain Medicine & Medical-Legal Evaluation

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Explore Advanced Treatment For Chronic Nerve And Spine-Related Pain

Chronic nerve pain can continue despite medication, injections, rehabilitation, surgery, or other treatments. Some patients experience burning, shooting, electric-like, or radiating pain, while others have persistent mechanical low back pain or problems with an existing implanted pain therapy system.
Neuromodulation uses targeted electrical stimulation to influence pain signals or restore function in selected muscles. Our pain management team evaluates your diagnosis, prior treatment, pain pattern, medical history, and goals to determine whether an implantable pain therapy may be appropriate.
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Conditions We Evaluate For Neuromodulation

Neuromodulation may be considered for selected patients with persistent neuropathic pain, focal peripheral nerve pain, complex regional pain syndrome, mechanical low back pain, or an existing stimulator that requires further evaluation.

We commonly evaluate patients experiencing:

  • Chronic neuropathic back pain
  • Chronic neuropathic neck pain
  • Radiating arm or leg pain
  • Persistent pain after spine surgery
  • Focal peripheral nerve pain
  • Suprascapular nerve pain
  • Cluneal neuralgia
  • Genicular nerve pain
  • Complex regional pain syndrome
  • Focal neuropathic pain suitable for DRG therapy
  • Chronic mechanical low back pain with multifidus dysfunction
  • Problems involving an existing spinal cord or peripheral nerve stimulator
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Spinal Cord Stimulation For Chronic Neuropathic Pain

Spinal cord stimulation may be considered for chronic neuropathic pain involving the back, neck, arms, or legs. These symptoms may develop after nerve injury, spinal degeneration, surgery, or another condition that affects pain signaling.

Patients may describe their symptoms as:

  • Burning or electric-like pain
  • Shooting pain into an arm or leg
  • Persistent tingling or painful sensitivity
  • Ongoing pain after spine surgery
  • Pain that has not improved adequately with other treatment
  • Symptoms that interfere with sleep, mobility, work, or daily life

Treatment options may include:

  • Dorsal column spinal cord stimulation trials
  • Spinal cord stimulator implantation
  • Generator replacement
  • Revision when indicated
A spinal cord stimulation trial allows the patient and provider to evaluate whether stimulation meaningfully reduces pain before a permanent system is implanted.
If the trial provides sufficient improvement, a permanent implant may be considered. Patients with an existing system may also be evaluated for generator replacement or revision when clinically indicated.
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Peripheral Nerve Stimulation For Focal Nerve Pain

Peripheral nerve stimulation targets a specific nerve associated with a localized area of pain. It may be considered when symptoms follow a recognizable peripheral nerve pathway and have not improved adequately with medication, injections, nerve blocks, or other care.

Treatment may involve:

  • Nalu peripheral nerve stimulation
  • Another appropriate peripheral nerve stimulation system
  • A temporary stimulation trial when applicable
  • Permanent implantation when appropriate

Common treatment targets may include:

  • Suprascapular nerves for chronic shoulder pain
  • Cluneal nerves for pain near the lower back or upper buttock
  • Genicular nerves for chronic knee pain
  • Other identifiable peripheral nerves
The specific nerve and stimulation system selected will depend on the location of the pain, diagnostic findings, prior response to nerve blocks, anatomy, and overall treatment goals.
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DRG Stimulation For CRPS And Focal Neuropathic Pain

Dorsal root ganglion stimulation, commonly called DRG stimulation, is a form of neuromodulation designed to target pain signals associated with specific areas of the body.

It may be evaluated for:

  • Complex regional pain syndrome
  • Focal neuropathic pain
  • Pain concentrated in a specific limb or region
  • Persistent nerve pain that has not responded adequately to other care

Treatment options may include:

  • DRG stimulation evaluation
  • A DRG treatment pathway when available and appropriate
  • Spinal cord stimulation evaluation
DRG stimulation may be considered when the pain is highly localized and the affected area can be addressed through a targeted approach. Availability and candidacy depend on the patient’s diagnosis, anatomy, prior treatment, medical history, and clinical assessment.
When DRG stimulation is not available or is not the most appropriate option, spinal cord stimulation may also be evaluated.

ReActiv8 Restorative Neurostimulation For Mechanical Low Back Pain

Some chronic mechanical low back pain may be associated with dysfunction of the multifidus muscles, which help stabilize the lumbar spine.

Patients may experience persistent low back pain that worsens with activity, standing, lifting, or changes in position. Symptoms may continue despite rehabilitation, medication, injections, or other conservative treatment.

Treatment options may include:

  • ReActiv8 restorative neurostimulation evaluation when appropriate and available

ReActiv8 is designed to stimulate nerves that activate the multifidus muscles. Unlike stimulation intended primarily to interrupt pain signals, restorative neurostimulation is intended to address dysfunction involving the muscles that support spinal stability.

This treatment is not appropriate for every type of low back pain. Evaluation focuses on whether the patient’s symptoms and clinical findings are consistent with chronic mechanical pain involving multifidus dysfunction.

Spinal Cord Stimulation Trials And Implants

A spinal cord stimulation treatment pathway typically begins with a detailed evaluation. When the patient appears to be an appropriate candidate, a temporary trial may be performed.

During the trial, stimulation leads are placed temporarily so the patient can assess whether the therapy improves pain and function.

The trial may help evaluate:

  • Reduction in pain
  • Improvement in sleep
  • Increased walking or activity tolerance
  • Ability to complete everyday tasks
  • Whether stimulation feels comfortable and manageable
  • Whether the improvement is meaningful enough to consider an implant
When the trial is successful, a permanent spinal cord stimulation system may be discussed. The type of system selected depends on the patient’s pain pattern, anatomy, treatment history, and clinical needs.

Existing Stimulator Revision And Generator Replacement

Patients with an existing spinal cord or peripheral nerve stimulation system may develop new symptoms or problems involving the implant.

These may include:

  • Reduced pain relief
  • A depleted or failing generator
  • Difficulty charging the system
  • Changes in stimulation coverage
  • Uncomfortable stimulation
  • Suspected lead movement or hardware problems
  • Problems communicating with the controller
  • A need for updated programming

Treatment options may include:

  • Revision evaluation
  • Generator replacement
  • Programming coordination
  • A hardware troubleshooting pathway

The first step is identifying whether the concern is related to programming, the generator, leads, another hardware component, or a change in the underlying pain condition.

Your provider may coordinate with the device manufacturer’s representative, review prior surgical records, or recommend imaging or other diagnostic steps when needed.

Programming And Hardware Troubleshooting

Neuromodulation systems may require programming adjustments over time as pain patterns, activity levels, or treatment needs change.

Programming coordination may help address:

  • Incomplete pain coverage
  • Changes in where stimulation is felt
  • Uncomfortable stimulation
  • Reduced effectiveness
  • New symptoms
  • Difficulty using or charging the device

When programming does not resolve the concern, a broader hardware evaluation may be needed. This may include reviewing the generator, lead position, connections, and prior implant information.

Revision or replacement is recommended only when the evaluation indicates that a procedural correction is appropriate.

What To Expect During A Neuromodulation Evaluation

Your evaluation may include a physical exam, a detailed review of your symptoms and treatment history, and a discussion of whether prior records, imaging, operative reports, or additional diagnostic steps are needed.

We may ask about:

  • Where your pain begins and where it travels
  • Whether symptoms are burning, shooting, electric-like, aching, or sensitive
  • Whether the pain is focal or affects a larger area
  • How long the symptoms have been present
  • Prior spine or nerve surgeries
  • Previous medications, injections, rehabilitation, or nerve blocks
  • Whether a diagnostic nerve block provided temporary relief
  • Whether you already have an implanted stimulator
  • How pain affects sleep, mobility, work, and daily activities
  • What level of improvement would feel meaningful to you

For patients with an existing device, we may also review:

  • The stimulator manufacturer and system type
  • When the system was implanted
  • Prior revisions or generator replacements
  • Current programming concerns
  • Charging or controller problems
  • Changes in pain relief over time

From there, we can discuss whether a stimulation trial, permanent implant, programming adjustment, revision, generator replacement, or another treatment may be appropriate.

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A More Individualized Approach To Implantable Pain Therapy

Not all chronic pain responds to the same form of neuromodulation. Widespread neuropathic pain, focal peripheral neuralgia, CRPS, and mechanical low back pain related to multifidus dysfunction may require different treatment strategies.

Our approach focuses on:

  • Identifying the likely source and pattern of pain
  • Distinguishing focal nerve pain from broader neuropathic symptoms
  • Reviewing prior treatment and diagnostic responses
  • Selecting the most appropriate stimulation target
  • Using a trial pathway before permanent implantation when applicable
  • Evaluating spinal cord, peripheral nerve, or DRG stimulation
  • Considering ReActiv8 when appropriate and available
  • Coordinating programming and device support
  • Evaluating revision or generator replacement when indicated
  • Helping patients understand the potential benefits and limitations clearly
An implanted pain therapy is not the right choice for every patient. A focused evaluation can help determine whether neuromodulation fits your diagnosis, treatment history, and goals.

Schedule A Neuromodulation Consultation

If chronic nerve pain, CRPS, focal peripheral pain, mechanical low back pain, or problems with an existing stimulator are interfering with your sleep, mobility, work, or daily life, our team can evaluate your condition and discuss available treatment options.
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Patient Stories

What To Expect At Your Visit

Your evaluation may include a physical exam, a review of your symptoms and history, and a discussion of whether additional imaging, records, or diagnostic steps are needed to better understand your condition and confidently recommend next steps.

We may ask about:

  • Where your pain starts and where it travels
  • How often symptoms occur
  • What the pain feels like
  • Triggers such as chewing, neck movement, stress, light, or touch
  • Prior medications, injections, imaging, or specialist visits
  • How symptoms affect sleep, work, focus, and daily life
From there, your provider can discuss which treatment options may be appropriate for your specific diagnosis and goals.

A More Targeted Approach To Headache And Facial Pain

Not all headaches or facial pain is the same. Chronic migraine, nerve pain, TMJ pain, and cervical spine-related headaches may require different treatment strategies.

Our approach focuses on:

  • Identifying the likely source of pain
  • Reducing unnecessary trial-and-error treatment
  • Using targeted injections or procedures when appropriate
  • Coordinating medication management when needed
  • Helping patients understand their options clearly

You do not have to keep guessing what is causing your pain. Schedule an evaluation to take the next step.

Schedule A Headache, Migraine, Or Facial Pain Consultation

If headaches, migraines, jaw pain, or facial nerve pain are interfering with your life, our team can help evaluate your symptoms and discuss treatment options.
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