Neuromodulation modality | Anatomic placement of device | Common pain indications | Special considerations |
Spinal cord stimulation | Cylindrical 8- or 16-contact leads that are placed in the epidural space via an interlaminar, percutaneous approach. Leads can be placed in the cervical, thoracic, or lumbar spine. |
| In patients with significant surgical hardware or abnormal anatomy, a paddle lead may be placed surgically. |
Dorsal root ganglion stimulation | Cylindrical 4-contact leads that are placed through the neuroforamen via the posterior epidural space through a curved introducer sheath. Leads typically placed from T10-S2 but other locations possible. |
| DRG stimulation is feasible in patients who do not have moderate or severe neuroforaminal stenosis. |
Peripheral nerve stimulation | Single or multi-contact leads are placed adjacent to peripheral nerves. Most currently available systems have an external power source that is worn by the patient. |
| Systems can be temporary or permanent. Lead designs and external power sources are highly variable. |
External stimulators | Variable; TENS units can be placed in painful areas of the extremities and back. Transcutaneous cranial (targeting distal branches of the trigeminal nerve) and vagal nerve (tVNS) stimulators target specific nerves in the head and neck, respectively. Vagal nerve stimulators can target the vagus nerve in the cervical or auricular regions. |
| No implantable leads or impulse generators. |
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