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Neuromodulation Techniques for Pain


Pain Medicine has evolved tremendously in recent years. Dr. Williams offers effective strategies to treat pain that do not involve medications and the related side-effects and complications that may range from occasional nuisance to catastrophic. Dr. Williams’ Center for Sports Neurology and Pain Medicine is comprised of Neurological Pain Medicine specialists and employ a Neurologically-oriented approach to acute, sub-acute, chronic, nociceptive, and neuropathic pain. While Dr. Williams and his team are experts in the rational and judicious prescription of medications for pain, he focuses on opportunities to apply the Neuromodulation techniques at his discretion.

Neuromodulation is the alteration of nerve activity through targeted delivery of a stimulus, such as electrical stimulation or chemical agents, to specific neurological sites in the body. In other words, we can turn up or turn down and off the specific peripheral nerves that are sending pain signals to reduce and/or eliminate pain. This can help enhance and improve physical function, professional and overall quality of life, sports performance, and self-esteem through neuromodulation.

Dr. Williams has successfully used Neuromodulation techniques on elite and professional athletes as well as collegiate, high school, and youth athletes to eliminate pain – allowing them to pursue and excel in high level, competitive, and aggressive physical activities without pain. In addition, Dr. Williams has successfully used these techniques in consultation with his expert Cedars-Sinai Kerlan-Jobe Institute surgical partners before and after surgery (and in some cases instead of surgery).

Not all of our patients are athletes. In fact, many of Dr. Williams’ patients are hardworking professionals who need to continue on the job without pain, elderly patients who want to maintain their physical function, and students who need to focus on studies and seek us out because they are tired of taking medications for pain relief. They are interested in safe and effective therapy options that eliminate medication-related side effects and reduce the unwanted exposure to opioid or narcotic medications. Listed below are examples of commonly used, safe, minimally invasive, and effective ways to alter peripheral nerve activity and pain through Neuromodulation.

Myoscience iovera°® Technology

Cryoablation has been used extensively for pain control over the years, but the newest technologies are far more precise relative to the temperatures applied and have a form factor that allows easy, safe, effective and minimally invasive in-office treatment. Myoscience’s iovera°® technology is a cryoablation tool typically used at the Center under ultrasound guidance to “freeze” selected superficial sensory nerves for the treatment of knee, foot, rib, and upper extremity pain as well as headache. The procedure usually lasts approximately 15-30 minutes. Patients may feel a cool, warm, or tingling sensation, but not pain. The Iovera cryoablation does not “kill” nerves. The target nerve will eventually regenerate (potentially after several months or longer) but can be retreated if necessary.

Bioness StimRouter

Bioness’ StimRouter peripheral nerve implants offer a safe, effective and minimally invasive way to target a specific peripheral nerve and deliver precise, focused electrical stimulation to block chronic pain. These procedures are performed with light sedation in our Kerlan-Jobe Surgery Center. The procedure involves placing a small electrical lead under the skin near the target nerve, using ultrasound or fluoroscopic guidance for precision. The procedure lasts approximately 30 minutes. During follow up, Dr. Williams, his team, and StimRouter experts assist in programming a personalized external pulse transmitter (applied to the skin overlying the implanted electrode) and remote. StimRouter empowers the implanted patient to have complete, customized wireless control in delivering the stimulation to the lead, and most importantly, relieving pain.

Radiofrequency Denervation (Rhizotomy)

Radiofrequency forms of Neuromodulation offer safe, effective and minimally invasive ways to target peripheral nerves and deliver precise, focused stimulation to block chronic, peripheral nerve pain. These procedures are performed in the Kerlan-Jobe Surgery Center. The procedure involves using a fluoroscope x-ray or ultrasound to visualize target structures. An electrode is temporarily placed adjacent to the nerve structure to be treated so that a radiofrequency signal can deliver carefully controlled stimulation (either continuous or in “pulses”) to a target nerve. This signal prevents nerves from sending pain signals and results in desensitization, reduction and/or elimination of pain. The procedure lasts approximately 15-30 minutes. There is light sedation and anesthesia involved to help with relaxation and comfort.

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