A Stimulating Technique to Relieve Agonizing Pain

t can hit after the most insignificant injury—a bang on the elbow or a twist of the wrist—but neuropathic pain, the kind that flares up after a nerve is injured, can be one of the most incapacitating afflictions a person experiences.

When the injury causes agonizing scarlike growths called neuromas, that look like tiny tumors on nerve endings, neurologists can try to relieve the pain with oral medication. But drug therapy can’t always do the trick. When it doesn’t, neurosurgeon Allan J. Belzberg will use one of several surgical methods to try to ease the misery—cutting out the neuroma, decompressing the nerve and removing scar tissue, or repairing the nerve with a graft.

surgeon Richard B. North, he’s part of a small vanguard of neurosurgeons nationwide who are turning to peripheral nerve stimulators to reduce the unforgettable pain caused by neuromas. The stimulator is im-planted by the neurosurgeon—rather like a pacemaker—and an electrode that’s placed near the nerve is what handles the discomfort. By delivering a controlled electrical impulse, it substitutes a tingling sensation for the pain—a much more tolerable feeling. Patients can turn the computers on and off and adjust them as needed.

North previously has used the stimulators to relieve spinal cord pain. Thanks to new computer chip technology, the device has been improved dramatically in the last several years. “They’re more controllable and more exact,” Belzberg says. “We can tweak and fine tune them, and patients are very happy indeed.”

For a good many people with neuropathic pain, the stimulator has, in fact, been a godsend. Belzberg remembers one patient who had gone from horror to horror before arriving in Hopkins’ busy nerve injury clinic. He’d started with minor discomfort in his arm from a decompressed nerve. Surgery at a community hospital had left him in worse pain, radiating from near his elbow down his arm into his hand. More operations and a steady diet of opiates didn’t help. Finally, Belzberg diagnosed a nerve injury and neuroma formation. “I placed the nerve stimulator on his radial nerve,” the surgeon says, “and for the first time in years he’s found relief.”

—- Anne Bennett Swingle