Dr. Ng adds that you
should also be aware that
another risk associated
with epidural steroid injec-
tions is nerve damage to
the patient. You can mini-
mize that risk by reviewing
the MRI and using fluo-
roscopy while performing
the injections, he says.
Steroid injections usually
work better for acute pain than chronic pain, says Dr. Cohen.
"Epidural steroid injections are the most common, and they clearly
work better for people who have a relatively short duration of pain,"
he says.
2. Neuromodulation
Neurostimulation or neuromodulation — the alteration of nerve activ-
ity through targeted delivery of a stimulus to a specific site in the
body — can include things like spinal cord stimulation, dorsal root
ganglion stimulation, deep brain stimulation and motor cortex stimu-
lation.
For example, for spinal cord stimulation, 2 electrodes are placed at
the back of the spinal cord, where they stimulate the dorsal columns
to inhibit pain in the back of the legs.
"With spinal cord stimulators, people feel kind of a vibratory sensa-
tion or a tingling instead of pain," says Dr. Cohen. "And because the
nerve fibers in the nerves that transmit those sensations are much
larger and travel faster, they crowd out the pain."
With some newer systems, spinal cord stimulation can alleviate pain
9 8 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • M A Y 2 0 1 9
• A LEG UP Epidural steroid injections temporize the pain for patients with
for spinal stenosis, disc herniations or pain shooting pains down the legs.
