Treatments 

Spinal Cord Stimulation (SCS) falls under a group of therapies known as neuromodulation. An SCS system is made up of an implanted battery which is attached to a pair of leads. The battery is implanted under the skin in the buttock area and the leads are put next to a nerves in the spine and programmed to transmit electrical pulses there - patients are able to control this using a handheld controller. This results in the selective interception of chronic pain signals travelling to the brain and can result in the reduction of pain felt by a person. A spinal cord stimulator can only treat certain types of pain. We recommend spinal cord stimulation for these conditions.

• Pain which is caused by an injury to the nerves (neuropathic), rather than pain caused by damage to the other tissues, such as the joints and muscles.

• Failed back surgery syndrome, when patients have neuropathic pain, rather than mechanical pain.

• Complex regional pain syndrome.

• Severe chronic pain that is limiting daily life, where all reasonable therapies (such as painkillers and physiotherapy) haven’t worked.

Occipital Nerve Stimulation (ONS) is another neuromodulation therapy. An ONS system is made up of an implanted battery which is attached to a pair of leads. The battery is implanted under the skin in the buttock area and two leads are placed underneath the skin at the back of the head near the occipital nerve. These leads are then tunnelled under the skin of the back and down to the buttocks where they are connected to the battery. The leads are programmed so that electrical impulses reach specific nerves - patients are able to control this using a handheld controller.  

Stimulation is thought to work by interfering with pain signals sent to the brain and possibly restoring balance with non-functioning nerves.

ONS is recommended for patients suffering from intractable Chronic Cluster Headaches (sudden, excruciating headaches that usually affect one side of the head and eyes, and occur in short bursts of time) and chronic migraines. 

ONS is a promising option for patients suffering from these conditions and can result in decreased medication use and decreaased frequency and intensity of attacks.

Multifidus stimulation is a type of neuromodulation therapy which falls under the cate restorative neurostimulation. Restorative neurostimulation is an emerging therapy aimed at reducing pain and disability from chronic mechanical low back pain by improving the function of muscles that stabilise the lumbar spine (multifidus muscle). 

A multifidus stimulation system is made up of an implanted battery which is attached to a pair of leads. The battery is implanted under the skin in the buttock area and the leads are put next to a nerves that supply the multifidus muscles on either side of the spine. These leads are then programmed to transmit electrical pulses to the multifidus muscle which cause it to contract which can help restore strength and functioning, which in turn causes a reduction in pain. 

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Multifidus stimulation is recommended for people suffering from mechanical chronic lower back pain - which is caused by stress or damage to joints, muscles, or ligaments rather than nerve damage. 

Monoclonal antibodies are proteins created in a laboratory to target specific cells or substances. Calcitonin Gene-Related Peptide (CGRP) is a protein that is involved in the transmission of pain signals in the nervous system. When a person has a migraine attack, CGRP is released by the nerves and this contributes to the symptoms experienced during an attack.

​​Eptinezumab is a monoclonal antibody that works by targeting and blocking (CGRP). By binding to CGRP and it’s receptor, eptinezumab stops it from working properly which can decrease frequency and severity of migraine attacks. Eptinezumab is administered by intravenous infusion during a hospital appointment every 3 months to patients suffering from chronic migraines. 

 

Monoclonal antibody therapy for patients suffering from chronic migraines tends to be used for patients who:

- Are having at least four migraine attacks a month and

- Have tried 3 or more different preventive medicines at the maximum doses they are able tolerate for several months each, with no improvement​