Neuromodulation Specialist

Pain Management Specialists -  - Board Certified Interventional Pain Management Physician

Pain Management Specialists

Board Certified Interventional Pain Management Physicians located in Rockville, MD & Frederick, MD

Do you suffer from back, neck, or limb pain that won't go away despite following a comprehensive treatment program? If so, board-certified interventional pain management physicians Stuart Hough, MD, and Ramani Peruvemba, MD, can help. At Pain Management Specialists in Rockville and Frederick, Maryland, they specialize in using state-of-the-art neuromodulation treatments such as the Nevro® HFX® high-frequency spinal cord stimulator, Abbott® Proclaim™ DRG Neurostimulator System and the Saluda Evoke™ spinal cord stimulator . Call Pain Management Specialists today to find out more or book an appointment online.


What is neuromodulation?

Neuromodulation is a treatment approach that uses electrical stimulation to affect the function of nerves. Pain Management Specialists is among the most experienced practices in the Washington, DC, area to use neuromodulation, and its team is still on the cutting edge of neuromodulation for pain management.

When used as a treatment for chronic pain disorders, neuromodulation takes the form of:

  • Spinal cord stimulation
  • Peripheral nerve stimulation
  • HFX therapy
  • SmartLoop therapy
  • Dorsal root ganglion (DRG) stimulation

Neuromodulation treatment involves implantation of a sophisticated medical device to deliver electrical stimulation to your nervous system.

What conditions can neuromodulation treat?

There are many applications for neuromodulation. Some of the more common are:

  • Complex regional pain syndrome (CRPS)
  • Neuropathy
  • Nerve injury
  • Radiculopathy
  • Failed back surgery syndrome
  • Residual limb or Stump pain
  • Phantom limb pain
  • Painful diabetic neuropathy (PDN)

Neuromodulation may be effective to treat pain caused by nerve damage if other approaches haven't been successful.

The Pain Management Specialists team is expanding the use of neuromodulation to successfully treat conditions like diabetic neuropathy and pelvic pain, as well.

What does neuromodulation implantation involve?

Implanting a neuromodulation device involves having a procedure to place leads near the spinal cord or the nerves outside your spinal cord. The leads, in turn, connect to a pulse generator, which contains both the brains and the battery powering the system.

The pulse generator delivers electrical signals to the nerves or spinal cord that interrupt the abnormal pain signals coming from damaged nerves. In most cases, you don’t feel anything but pain relief. But some forms of neuromodulation cause a paresthesia, or tingling sensation in the area where you have pain. You can control the stimulation using a hand-held device.

Before having an implant, you need to complete a trial of neuromodulation to see how effectively it reduces your pain. After a successful trial, you can undergo the full implantation procedure.

The Pain Management Specialists physicians are among just a few pain management providers who have experience in both neuromodulation trials and implant procedures. This means they can care for you from your initial assessment through surgery to the maintenance phase.

What are the latest developments in neuromodulation?

Several medical device manufacturers make neuromodulation devices, but the Pain Management Specialists team primarily uses four of the most advanced and effective neuromodulation devices available:

Nevro HFX Therapy

Nevro holds the patent on high-frequency spinal cord stimulation, called HFX. Introduced to the US in 2015, it's the first type of spinal cord stimulation to deliver effective pain relief without causing paresthesia, and the first to be proven superior to other forms of spinal cord stimulation. In a prospective 2 year study, 76% of patients with severe back and leg pain reported at least 50% back pain relief, while only 49% of patients receiving conventional spinal cord stimulation reported 50% relief. Additionally, HFX therapy is the first FDA-approved non-drug treatment for painful diabetic neuropathy, a condition that afflicts millions of Americans. Dr. Hough was the first doctor in Maryland to trial and implant a Nevro spinal cord stimulator system and has more experience with Nevro devices than anyone in the area.

Saluda Evoke SmartLoop Therapy

Saluda holds the patent on closed-loop spinal cord stimulation, called Evoke. Introduced to the US in 2023, it's the first type of spinal cord stimulation to sense the electrical response of the spinal cord (the evoked compound action potential) to electrical stimulation, then to automatically adjust the stimulation intensity to maintain a stable response and pain relief from moment to moment. Three year data from 134 patients with severe low back and leg pain show that SmartLoop therapy reduces pain intensity by at least 50% in 77% of implanted patients, while open-loop stimulation was effective in only 50% of patients.

Abbott Proclaim DRG Neurostimulator System

The Pain Management Specialists team is one of few with training and experience in using Abbott's Proclaim dorsal root ganglion stimulator, and they regularly receive referrals from other pain management doctors for this treatment. Dorsal root ganglion stimulation was proven superior to conventional spinal cord stimulation for the treatment of pain caused by chronic regional pain syndrome and peripheral causalgia, which results from nerve injury.

Medtronic DTM Spinal Cord stimulation

Metronic Introduced DTM spinal cord stimulation to the US in early 2020. Using the advanced Medtronic Intellis pulse generator, DTM has been shown to be superior to conventional spinal cord stimulation in a head-to-head comparison. 

To find out how neuromodulation could ease your chronic pain, call Pain Management Specialists today or book an appointment online.