Overview
Implant-based pain therapies represent the highest level of interventional pain medicine — devices placed within the body that provide continuous, programmable, adjustable pain relief for patients with complex, refractory chronic pain. Dr. Migdale is fellowship-trained in the full spectrum of implantable therapies: spinal cord stimulation (SCS), dorsal root ganglion (DRG) stimulation, peripheral nerve stimulation (PNS), and intrathecal drug delivery systems. These therapies are not first-line treatments — they are typically recommended after conservative measures and less invasive interventional treatments have been appropriately trialed.
Who Are Implant-Based Therapies For?
Implantable devices are appropriate for patients with: refractory chronic pain that has not responded adequately to medications and injection-based treatments; neuropathic pain conditions such as CRPS, failed back surgery syndrome, and peripheral neuropathy; pain syndromes where ongoing opioid therapy poses unacceptable risks; and conditions where the evidence base strongly supports neuromodulation over continued conservative care.
The Technology Has Transformed
Modern implantable pain devices are sophisticated, miniaturized, and designed for life alongside the patient. Rechargeable batteries last 10–15 years. MRI-conditional systems allow post-implant imaging. Closed-loop SCS systems automatically adjust stimulation based on real-time neural feedback. Remote programming capabilities allow patients to adjust their own stimulation within physician-defined parameters from a smartphone app.
The Evaluation Process
Before implantation, Dr. Migdale conducts a comprehensive evaluation including review of prior treatments, psychological screening, imaging review, and a detailed discussion of realistic expectations. For SCS and DRG stimulation, a trial period precedes permanent implantation. This process ensures that the right patients receive these therapies and that expectations are appropriately calibrated.