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Does Size Matter In Neuromodulation

This presentation explores the multifaceted role of size in neuromodulation, from electrode spacing and lead configurations to IPG dimensions, waveform characteristics, and energy delivery. Dr. Valimahomed discusses how different lead lengths, spacing, and configurations impact stimulation coverage and efficacy—particularly in spinal cord and peripheral nerve stimulation. He also analyzes how IPG size affects patient comfort, pocket pain, infection risk, and therapy adoption. Future-forward technologies like injectable and bioresorbable systems, AI-based programming, and neural dose optimization offer promising paths to miniaturization and precision. Ultimately, size matters—but contextually, depending on anatomical targets, clinical goals, and device trade-offs.

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(L) Dr. Leonardo Kapural – Neuromodulation for Peripheral Neuropathy vs Mononeuropathy – Video Hero Slider

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Neuromodulation for Peripheral Neuropathy vs Mononeuropathy

In this insightful lecture, Dr. Leonardo Kapural reflects on 13 years of contributions to the Mediterranean Pain Forum and presents cutting-edge advancements in neuromodulation. Highlighting data from multiple studies, including magnetic and high-frequency peripheral nerve stimulation, the talk explores non-invasive alternatives to medication for neuropathic and diabetic pain, mononeuropathy, and post-amputation pain. With comparisons to traditional drugs like gabapentin, the speaker emphasizes the greater efficacy and patient satisfaction of neuromodulation. He also traces the evolution of techniques from invasive surgical placements to modern ultrasound-guided approaches and compact external stimulators, calling for earlier adoption of neuromodulation in pain treatment algorithms.

Neuromodulation for Visceral Pain

Dr. Andrew Kaufman presents a comprehensive review of spinal cord stimulation (SCS) for visceral pain, including anginal, abdominal, pancreatic, and pelvic pain. He discusses the complexity of visceral pain pathways and the challenges in diagnosis and treatment. Highlighting key studies—including those using high-frequency (10 kHz) and traditional SCS—Dr. Kaufman showcases improvements in pain relief, opioid reduction, and quality of life. However, he emphasizes the variability in outcomes, the need for better patient selection, and the lack of robust randomized studies. A recent sham-controlled trial even questions efficacy for chronic pancreatitis, reinforcing the importance of refining protocols.

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Salvage for SCS

This talk addresses salvage strategies for spinal cord stimulation (SCS), focusing on patients who experience loss of efficacy, unwanted sensations, or recharge difficulties. Traditional responses like reprogramming, stimulation holidays, waveform switching, or IPG replacement often still target the dorsal column, leading to repeated, ineffective interventions. The speaker proposes a paradigm shift: exploring dorsal root ganglion (DRG) stimulation as an alternative target. DRG offers new therapeutic coverage for complex pain regions, especially in patients with failed SCS systems. A retrospective review of 60 patients demonstrated significant pain relief and opioid reduction using DRG, making it a promising salvage strategy in interventional pain management.

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(L) Dr. Robert Rapcan – Direct Optic View for Annular Tear Repair Using Bone Marrow Derived Stem Cells – Video Hero Slider

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In this comprehensive lecture, Dr. Robert Rapcan explores the combination of regenerative therapy and mechanical techniques for treating discogenic pain. He emphasizes that stem cell injections alone may not provide immediate relief and advocates combining them with procedures like thermal annuloplasty. Detailed insights are provided into intradiscal and annular tear injections under direct optic vision, with early data suggesting improved outcomes in elite athletes and general patients. The discussion covers diagnostic challenges, MRI findings, biomechanical factors, and the pathophysiology of painful discs. A small pilot study shows promising improvements in pain and function, though complications like discitis are acknowledged.

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Direct Optic View for Annular Tear Repair Using Bone Marrow Derived Stem Cells