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pain and/or psychologica l impacts of chronic pain. Some studies have shown a negative impact on cognitive function and memory in patients with chronic pain, showing loss of neocortical gray matter on bra in sca ns a nd cha nges in bra in chemistry. Studies have also shown a link between chronic pain and increased risk for cardiovascular disease, which may be in part due to difficulty performing regular cardiovascular exercise secondary to pain's negative effect on mobility. Given t he mu ltit ude of long-ter m adverse ef fects, chronic pa in is not something to be ignored. Fortunately, the medical field continues to produce technologica l advances that could be the answer for these patients as they search for ways to alleviate their pain and regain function. HOPE FOR PEOPLE WITH PAIN REFRACTORY TO TREATMENT While neuromodulation can be life-chang- ing for some, it is not a first-line therapy. Specifically, neuromodulation is reserved for those who have tried and failed other medical treatments appropriate for their conditions. These first-line treatments may include pha rmacolog ic therapy, physica l therapy, holistic mea sures, neuropsychological testing, surgery to correct structural problems, injections and/or ablation. Ho w e v e r, w h e n t h e s e t h e r a pi e s f a i l , i n n o v a t i v e n e u r om o d u l a t i on devices may provide significant relief. Neuromodulation may sometimes offer modest benefits, which can still make a significant difference in patients' lives; at other times, it can make a tremendous difference, according to Dr. Snyder. TYPES OF NEUROMODULATION DEVICES S ever a l t y pe s of neu romodu l at ion devices exist on the market today (see "Neuromodulation Devices Available at NSPC" on page 9) and may be used for chronic pain refractory to conventional treatments, as well as treating several other medical conditions (see "Conditions Treated" on page 8). Most neuromodu- lation devices require implantation of a neurostimulator device with electrodes placed at the target site. Patients can often control their neurostimulator with a remote device. In general, neurostimu- lation works by using electrical impulses to interrupt the pain signal to the brain, replacing the perception of pain with a much more tolerable tingling sensation (paresthesia). However, some newer devices on the mar- ket are capable of neurostimulation without perceivable paresthesias for patients who find the paresthesias uncomfortable. The neurosurgeon typically begins the patient on a trial period with a temporary neurostimulator in order to eva luate efficacy prior to placement of a perma- nent device. An intrathecal pump is another neu- romodulating device that ultimately allows medication to be infused into the intrathecal space, reaching receptors at the target site more efficiently than systemic medications. "This technology is advancing rapidly," Dr. Snyder says. "It's extremely versatile, and there are numerous opportunities to help different patients, as well as mul- tiple interventions that may help any given patient." Brian Snyder, MD, neurosurgeon at NSPC Brain & Spine Surgery, confers with a postsurgical patient. A board-certified and fellowship- trained neurosurgeon, Dr. Snyder studies an MRI image of a patient's thoracic spine. Dr. Snyder is an expert in using neuromodulation to treat chronic pain. M D N E W S . C O M /// M D N E W S L O N G I S L A N D ■ 2 0 2 2 0 7