Center for Neuromodulation at Johns Hopkins

Therapies offered:

• Spinal Cord Stimulation (SCS) or Dorsal Column Sitmulation
  • Complex Regional Pain Syndrome Type I (CRPS) formerly Reflex Sympathetic Dystrophy (RSD)
  • Complex Regional Pain Syndrome Type II (CRPS) formerly Causalgia
  • Failed Back Surgical Syndrome (FBSS) or Post-laminectomy Syndrome
  • Small Fiber Peripheral Neuropathy
  • Chemotherapy-induced Peripheral Neuropathy
  • Diabetic Peripheral Neuropathy
  • Idiopathic Peripheral Neuropathy
  • Angina (Chest-Pain) non-reponsive to revascularization or medical management
  • Peripheral Vascular Disease (PVD) or Peripheral Arterial Occlusive Disease (PaOD)
  • Pelvic Pain
  • Idiopathic Pancreatitis
• Peripheral Nerve Stimulation (PNS)
  • Occipital Neuralgia
  • Supratrochlear/Supraorbital Neuralgia
• Sacral Nerve Stimulation (SNS)
  • Pudendal Neuralgia
  • Vulvodynia
• Intrathecal Medication Pumps
  • Spasticity/clonus
    • related to Multiple Sclerosis
    • related to Spinal Cord Injury
    • related to cerebrovascular accidents (CVA) or Brain Stroke ("Brain Attack")
  • Malignant (Cancer-related) pain

Associated Faculty:

• Robert W. Hurley, M.D./Ph.D.
  • Medical Director of the Johns Hopkins Blaustein Pain Treatment Center
  • Director of the Neuromodulation Center at Johns Hopkins
  • Department of Anesthesiology and Pain Medicine
• Fredrick Lenz, M.D./Ph.D.
  • Professor, Dept of Neurosurgery
• Stephen Wegener, Ph.D.
  • Associate Professor of Psychology
  • Dept. of Physical Medicine and Rehabilitation
• Beth Murinson, M.D.
  • Assistant Professor, Dept. of Neurology
• Michael Erdek, M.D.
  • Assistant Professor, Dept. of Anesthesiology and Pain Medicine

What to expect when you visit the Center for Neuromodulation at Johns Hopkins:

Spinal Cord, Sacral Nerve Root, Peripheral Nerve Stimulators

1. You will be evaluated by one of our Pain Medicine Physicians for the appropriateness of this therapy for your pain condition
2. If you wish to go forward with the therapy, you will see our Pain Psychologist for an evaluation prior to implantation. The purpose of this consultation is to determine your understanding of the therapy and to assess your expectations.
3. You will be scheduled for the stimulator "trial".  What this involves is a visit to our pain clinic to have a trial lead placed.
   1. You will come for this procedure, like all other surgical procedures you will fast for 8 hours prior to the procedure
   2. You will have an I.V. placed
   3. You will receive mild sedation for the procedure, if necessary
   4. The lead will be placed through your skin using local anesthesia (numbing-medicine) and fluoroscopic (X-ray) guidance
   5. Once the lead is in the appropriate position, we will turn the lead on and determine that you have the appropriate sensations in the the area of your body where you have pain
   6. The lead will then be secured to your skin and connected to the external computer (a small box about the size of an ipod)
   7. You will then be provided with a number of programs to relieve your pain
   8. Three to seven days after placement of the lead you will return to the Neuromodulation Center to assess your reponse to this trial period and lead removal
4. If you wish to go forward with the therapy, you will be scheduled for surgery
5. After the surgery, you will be seen in the Center for assessment of the therapy, re-programming and evaluation of the surgical incision (and removal of staples, if necessary)

Intrathecal Therapies

1. You will be evaluated by one of our Pain Medicine Physicians for the appropriateness of this therapy for your pain condition
2. If you wish to go forward with the therapy, you will see our Pain Psychologist for an evaluation prior to implantation. The purpose of this consultation is to determine your understanding of the therapy and to assess your expectations.
3. You will be scheduled for the stimulator "trial".  What this involves is a visit to our pain clinic to have a trial catheter placed.
   1. You will come for this procedure, like all other surgical procedures you will fast for 8 hours prior to the procedure
   2. You will have an I.V. placed
   3. You will receive mild sedation for the procedure, if necessary
   4. The catheter will be placed through your skin using local anesthesia (numbing-medicine) and fluoroscopic (X-ray) guidance
   5. Once the lead is in the appropriate position, we will place the catheter under your skin and it will exit your skin on teh side of your body about at the level of your hip.
   6. You will then be admitted to the hospital for an inpatient stay.  The length of this stay in the hospital will be determined by the type of medications that are planned to be used in your pump.  For instance, baclofen for spasticity will be approximately a 1 to 2 day stay.  Opioids for cancer pain can be up to 7 days.
   7. The catheter will be removed at the end of the trial and you will resume you oral medications.
4. If you wish to go forward with the therapy, you will be scheduled for surgery 1 week to 1 month following removal of the catheter. This interval is necessary to decrease the risk to you of infection.
5. After the surgery, you will be seen in the Center for assessment of the therapy, re-programming of the pump and evaluation of the surgical incision (and removal of staples, if necessary)