Remote Electrical Neuromodulation (REN)
Remote electrical neuromodulation (REN)
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Remote electrical neuromodulation (REN) is a non-invasive treatment method that uses a wearable device to send electrical pulses for pain and headache management. It activates the body's natural pain management mechanism, called conditioned pain modulation (CPM). The REN device, Nerivio®, stimulates specific nerve fibers in the upper arm, known as Aδ and C fibers, sending signals to the pain regulation centers in the brain, which activates the body's natural CPM descending pain inhibitory system. This descending pain inhibitory system sends signals which release serotonin and norepinephrine, neurotransmitters that our body releases to provide natural pain relief. The REN device has a global impact on pain, so the device can be used on either arm independently from the side of a unilateral headache. [1,2]​
Nerivio®
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Dr. Wang has chosen the FDA-approved Nerivio® wearable device to offer to patients who are interested in a drug-free way to manage and to prevent migraine headaches. Nerivio® is a FDA-cleared wearable, wireless, battery-operated REN stimulation unit, controlled by a smartphone application. For the acute treatment of migraine attacks the device is applied for 45 min to the upper arm. It is available by prescription only and it's currently the only drug-free migraine therapy covered by Medicaid and most commerical insurances.
The Nerivio® device has been FDA-approved for:
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patients over the age of 8 years
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acute and preventive treatment of migraine headaches
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Please note: Nerivio® is not appropriate for patients with uncontrolled epilepsy, an implanted medical device such as pacemakers, hearing aid implant, or any implanted electronic device. Such use could cause electric shock, electrical interference, or serious injuries or medical conditions.
References:
[1] Tepper SJ, Rabany L, Cowan RP, Smith TR, Grosberg BM, Torphy BD, Harris D, Vizel M, Ironi A, Stark-Inbar A, Blumenfeld AM. Remote electrical neuromodulation for migraine prevention: A double-blind, randomized, placebo-controlled clinical trial. Headache. 2023 Mar;63(3):377-389. doi: 10.1111/head.14469. Epub 2023 Jan 27. PMID: 36704988.
[2] Hershey AD, Lin T, Gruper Y, Harris D, Ironi A, Berk T, Szperka CL, Berenson F. Remote electrical neuromodulation for acute treatment of migraine in adolescents. Headache. 2021 Feb;61(2):310-317. doi: 10.1111/head.14042. Epub 2020 Dec 21. PMID: 33349920.
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