Implantable technology for pain management

The conventional management of chronic pain can be unsatisfactory. Implantable technology allows electronic and mechanical devices to be used for neuromodulation at any site in the CNS. Neurochemical transmission in the dorsal horn of the spinal cord can be modulated by electrical stimulation or direct drug delivery. Systems available for stimulation include single or dual multipolar electrodes that can be implanted extradurally via a percutaneous route. Tunnelled subcutaneous connections can be made to an implanted electrical pulse generator capable of multifunction stimulation with a transcutaneous reprogramming facility. Stimulation is useful for chronic mixed spinal and neuropathic pain, refractory angina and peripheral vascular disease. Using a similar technique, an intraspinal catheter can be sited to deliver a drug. It is connected to an implanted electromechanical pump that can be programmed transcutaneously to deliver combinations of drug and dose regimens, allowing reductions in dose requirements and more accurate neuromodulation. This system is particularly useful in palliative care.