Neurotech for Pain and Bladder Control

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The BiowavePRO unit, when used with Biowave Percutaneous Electrodes, is called BiowavePENS.

Neurotechnology, the application of medical electronics to the human nervous system, is a field that addresses many needs of people with disabilities. Devices have expanded to combat life-threatening conditions, enhance daily function and improve overall health. Although hidden, urinary incontinence and chronic pain are two conditions that have great impact on our daily lives. Whether it is the struggle to get out of bed or dealing with soaked clothing, either condition can turn your world upside down. Typical methods to manage bladder or chronic pain include oral medications, injections or even acupuncture, but there are also alternatives available from the world of neurotechnology.

Managing Chronic Pain and Spasticity
Pain comes in many types and intensities. According to the Neuropathy Association, there are more than 100 types of neuropathy. The following neurotechnology options may look like alphabet soup, but this overview will decode and introduce you to the array of devices:

TENS/MET/PENS — These systems may help alleviate pain by using electrical stimulation to block the messages being sent to the brain. TENS (transcutaneous electrical nerve stimulation) delivers stimulation through electrodes placed directly on the skin in the affected area. MET (microcurrent electrotherapy) works in the same way but uses different parameters, such as waveforms and frequencies. PENS (percutaneous neuromodulation systems) also applies stimulation through the skin, but uses microscopic needles for a deep tissue delivery. Electrodes come in all shapes and sizes from small round gel pads to large custom garments. They are non-invasive and can be an economical solution for pain management.

IDDS (implanted drug delivery systems) are also referred to as intrathecal analgesia therapy, a pain management method for those who find oral medications ineffective or side effects difficult to tolerate. A device administers medicine, such as baclofen, through a surgically implanted pump that can reduce the need for oral medications and deliver more effective therapy.

Perc-Electrode-with-DetailSCS (spinal cord stimulation) systems also use electrical stimulation to block the pain messages to the brain but in a very different way. SCS are surgically implanted systems in which electrodes are placed in the spine. The user has an external unit to control the system. Typically an initial trial is needed to see if it is effective prior to implanting a permanent system.

Other alternatives for pain — The FDA has approved infrared therapy and cortical stimulation as non-invasive methods for treating chronic pain. They are both relatively new to the marketplace in the U.S. but have clinical evidence supporting the therapies. There is also an array of devices currently in development; some include implanted nerve blocking strategies, transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS).

All these options offer alternative means of treating chronic pain. One device does not fit all types of pain. Finding the right pain management method can be best accomplished by trying different alternatives.

Controlling the Bladder
Research published by Dr. Kim Anderson-Erisman, a quad and member of the SCI Hall of Fame, highlights bladder management as the number one issue among persons living with spinal cord injury. But bladder control is not just an SCI issue; there are many disabilities that cause urinary incontinence and the inconveniences that come along with it. Here are five types of devices to help manage the bladder.

Sacral Nerve Stimulation: This is a surgically implanted device that sends electrical impulses to the sacral nerve that controls the bladder, its sphincter, and the muscles around it. This operates by blocking the signal from the bladder to the brain.

Tibial Nerve Stimulation: This device controls the bladder through percutaneous stimulation of the tibial nerve, similar to the electrodes used to control pain. This is administered as an in-office treatment and is used to treat overactive bladder.

Pelvic Floor Stimulation: Also an in-office treatment, this device is completely external, applying electrical stimulation to the pelvic floor muscle. Generally delivered by a probe connected to an external pulse generator, stimulation may enhance voluntary opening and closing of the urethra.

Bladder Muscle Stimulation: FDA approved in the U.S. as the VOCARE system, this device directly stimulates the bladder muscle with implanted electrodes. It is available in several countries, including the United Kingdom and around Europe as the FineTech-Brindley Bladder System. The system includes surgically implanted internal components and an external unit that allows the user to control the system.

Investigational Devices: There are many methods under investigation for managing incontinence: the pudendal nerve stimulator, urethral nerve stimulation, and sphincter nerve block are all options being reviewed for effectiveness and safety.

Each of these therapies can help improve control of the bladder, provide peace of mind and offer more independence. However, these approaches should be discussed with a knowledgeable urologist.

More Technology and Tools
Neurotechnological tools suppress symptoms, modulate neural pathways or gain daily function. Wearable technologies help with hand function or replace an AFO (ankle-foot orthosis) due to drop foot syndrome. E-stim units can be used for exercise and prevention. Rehabilitation has changed with the introduction of robotics, exoskeletons and repetitive motion therapy.

The way we approach therapy is a continuum over a person’s lifetime. Neural prostheses can provide independent breathing, cough, trunk control, standing or walking. Systems are not one-size fits all, and there is no instant gratification. Neurotechnology is customized and intelligently designed. The point is that the technology must be properly fitted and takes a commitment to get the desired results, like any exercise plan.

The neurotechnology field is rapidly changing and the industry is helping to gain access to these technologies. Some manufacturers offer support groups to get connected to people who use the devices, while others have “Find a Doctor” features on their websites to get connected with a trained medical professional. Many are working to help get financial reimbursement. Neurotech Network strives to be a consumer resource for this field, offering free resources and education sessions.

To learn more, visit www.NeurotechNetwork.org.

Neurotech Network is a nonprofit organization focusing on education and information dissemination about neurotechnology for persons with impairments. The website provides many resources for free, including education pages and an Internet-based searchable database of neurotechnology devices. Jennifer French has a C6-7 SCI and is a user of the implanted stand-and-transfer system developed by the Cleveland FES Center. She is the co-founder of Neurotech Network.

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  1. Ed says:

    There is in fact a transcranial direct current stimulator already on the market, cleared by the FDA, and sold to the public – http://www.fisherwallace.com/

    One recent study showed no benefit of tDCS for the very small number of SCI patients enrolled (http://www.ncbi.nlm.nih.gov/pubmed/23831866), though others have suggested that it works for some individuals. People willing to slog through a technical review can do so for free here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3584797/

    The Fisher-Wallace stimulator is expensive, and remains unproven for SCI pain. Hopefully further studies will be done, given the intractable suffering experienced by many people.

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