To look at Stephen Wright, you’d think he was a professional athlete or at least a former collegiate athlete.

The 29-year-old Cross native looks like the picture of health. He even remains active, running three times a week, lifting weights and playing basketball.

But outward appearances and activities can be deceiving. Since 2004, Wright has suffered in agonizing pain.

“It affects my life in so many different ways,” says Wright, who works as a substitute teacher. “So often, I’m irritable. My personality is so much different than it used to be when I was younger. I was lively. I had more fun. I laughed a lot. I’m more serious now because I’m dealing with serious pain. It affects my life every day.”

Stephen Wright, who was diagnosed with interstitial cystitis in July, peruses self-improvement books at Books-a-Million in Northwoods Mall. While he is in constant pain, the 29-year-old Cross resident said he still manages to lead an active life.
Not until this summer, however, did Wright understand what was causing it.

In July, he was diagnosed with interstitial cystitis, a painful condition due to inflammation of the tissues of the bladder wall. Wright says he has chronic pain in the perineum area, often with a burning sensation in his lower back. Other common symptoms of IC include the need to urinate frequently and, in women, pain during intercourse.

In 2009, the RAND IC Epidemiology Study, the first large-scale study of the condition, surveyed more than 100,000 households in United States and estimated that 3 million to 8 million women have it. Government estimates for men set the number at 1 million.

As in Wright’s case, the condition often is misdiagnosed initially. He was diagnosed with prostatitis, an infection of the prostate gland. A diagnosis often takes place after other conditions, such as urinary tract infections and sexually transmitted diseases, are ruled out.

According to the National Institutes of Health, patients with interstitial cystitis don’t get a proper diagnosis on average for four years after the first symptoms occur.

Dr. Dennis Kubinsky, a urologist with Charleston Urology Associates, says the symptoms often mimic a bladder infection and that many doctors and patients give up trying to diagnose and treat it.

“There are definitely some doctors that don’t have the patience to treat it and who think it’s a mental problem. It’s definitely not a mental problem,” says Kubinsky, adding that while IC is not life-threatening, it can be debilitating.

“There’s a lot of trial-and-error in treating it, and it usually involves multiple modalities,” says Kubinsky, who is affiliated with Roper St. Francis Healthcare. “We can usually figure out a regimen that can improve their (an IC patient’s) life.”

Treatment options Kubinsky outlined include a combination of a low dose of antidepressant to fight inflammation, drugs to help to coat the bladder and pain medications. Currently, Botox is being used as an experimental treatment.

Many patients find relief in altering their diets, specifically by eliminating acidic foods and beverages such as coffee, tea, soft drinks, alcohol, citrus fruits and juices, tomatoes and hot pepper, along with monosodium glutamate and artificial sweeteners.

Changing her diet was “the only thing that made a difference” for managing interstitial cystitis for 40-year-old Charleston resident Tina Dean, a former bookstore manager who is now a full-time student. She has suffered with IC for a decade.

“Diet plays a huge role in how I feel from one day to the next,” says Dean. “I went on the ‘Flat Belly Diet’ and it put me into a full remission. The combination of organic, fresh foods, and no salt, no sugar, nothing from a can or a box was pretty easy to stick to.”

She also avoids soy products, coffee and tea, dark-colored sodas and diet drinks, especially with the artificial sweetener aspartame.

Dean adds she also has taken two drugs, amitriptyline and hydroxyzine, for five years and will “never go off of them if I can help it.”

“I still have bad days, but they are few and far between,” says Dean, adding that no one at the store ever suspected she had a condition. “There were plenty of days where I didn’t think I was going to make it through the day, but I just kept going. A lot about this disease is mental. You have to make yourself keep going, even on the days when you just want to lie in bed and die. Trust me, anyone with IC has had these days.”

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Interstitial cystitis awareness
Patients often face criticism and shaming from medical professionals and/or family members who do not think the interstitial cystitis condition is real.

Considered an “invisible illness,” most IC patients look healthy despite having severe urinary symptoms and/or pelvic pain.

Children and teens with IC have been accused of seeking attention and denied access to restrooms in schools. Young adults may face accusations of having sexually transmitted diseases.

The cause of IC is unknown, though research into prostatitis released earlier this year by Northwestern University suggests that one strain of E-coli (UPEC) may trigger a “pain response” that persists after the infection has been treated and bacteria is no longer found in the urinary tract.

Tragically, a growing number of young adults around the world have developed IC-like symptoms after using ketamine, a drug popular at raves and parties. Ketamine, often known by the street name Special K, has been shown to cause severe ulceration of the bladder wall as well as some kidney damage.

Diet modification and the avoidance of high-acid foods such as coffee, tea, green tea and soda are beneficial for many patients.

Healthy Sources of Vitamin D
Released: 5/11/2011 9:00 AM EDT
Source: University of Texas M. D. Anderson Cancer Center

Newswise — HOUSTON – The recent increase in recommended vitamin D intake from the Food and Nutrition Board may prompt some to seek more summer sun. But, experts at The University of Texas MD Anderson Cancer Center say there’s no safe amount of time people can stay in the sun without increasing skin cancer risks.

People tend to think of sunshine when they think of vitamin D — and for good reason. When UV rays come in contact with the skin, it triggers the creation of vitamin D.

“Some people may absorb enough vitamin D from their routine outdoor exposure,” says Susan Y. Chon, M.D., assistant professor in MD Anderson’s Department of Dermatology. “However, the benefits of UV exposure may be limited because they can lead to increased risks of developing skin cancer.” On a hot summer day, unprotected skin can be damaged in as little as 15 minutes.

Add vitamin D to your diet

So, why is vitamin D so important? It’s the main building block for maintaining bone health. Without it, you can develop thin and brittle bones. Vitamin D also boosts the immune system to help fight off germs, bacteria and diseases, including certain cancers.

To avoid skin cancer, Chon recommends getting the daily fill of vitamin D from foods and, if necessary, supplements.

A handful of foods provide a large serving of this vitamin, including:
• Cod liver oil: According to the National Institutes of Health, this fish extract provides the largest amount of vitamin D — just one tablespoon offers 1,360 IUs (International Units).
• Fish: One serving (about three ounces) of certain types of fish also can give you a healthy dose of vitamin D. This includes:
o Salmon: Provides 447 IUs per serving
o Mackerel: Provides 388 IUs per serving
o Tuna: Provides 154 IUs per serving
• Milk: Milk really does a body good. Just one cup of whole, reduced fat or non-fat milk is fortified with vitamin D and provides 115 – 124 IUs.
• Fortified cereals: Ready-to-eat cereals, fortified with 10 percent of the daily recommendation for vitamin D, are an easy way sneak in extra nutrients. A three-quarter to one cup serving can provide at least 40 IUs.
Vitamin D needs aren’t one-size-fits-all

The amount of vitamin D the body needs depends mostly on age. Below are the daily recommended allowances from the Food and Nutrition Board.
• Birth to 12 months: 400 IUs
• Age 1 to 70: 600 IUs
• Age 70 and older: 800 IUs

Most people can get their daily fill of vitamin D by drinking a cup of milk and eating a three-ounce serving of salmon.

“There’s no doubt that vitamin D is vital when it comes to healthy bones and preventing diseases like cancer,” Chon says. “But, there’s no need to sacrifice sun safety (like skipping sunscreen or spending countless hours soaking in the rays) to get your fill.”

For more vitamin D and sun safety information, visit www.mdanderson.org/focused.

Source: Ohio State University Center for Clinical and Translational Science

Newswise — COLUMBUS, Ohio – A recent study gauging the impact of consuming more fish oil showed a marked reduction both in inflammation and, surprisingly, in anxiety among a cohort of healthy young people.
The research, supported by the Ohio State University Center for Clinical and Translational Science (CCTS), was conducted by a team of scientists that has spent more than three decades investigating links between psychological stress and immunity.

“The findings suggest that if young people can get improvements from dietary supplements, then the elderly and people at high risk for certain diseases might benefit even more,” said Janice Kiecolt-Glaser, professor of psychiatry and author of the study, which was published this month in the journal Brain, Behavior and Immunity. “The more we understand about the complex interplay between inflammation and immunity, the closer we’ll get to figuring out which lifestyle choices and changes have the biggest impact on long term health.”
Omega-3 polyunsaturated fatty acids, such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have long been considered as positive additives to the diet.

Earlier research suggested that the compounds might play a role in reducing the level of cytokines in the body, compounds that promote inflammation, and perhaps even reduce depression. Psychological stress has repeatedly been shown to increase cytokine production so the researchers wondered if increasing omega-3 might mitigate that process, reducing inflammation.

To test their theory, they turned to a familiar group of research subjects – medical students. Some of the earliest work these scientists did showed that stress from important medical school tests lowered students’ immune status.
“We hypothesized that giving some students omega-3 supplements would decrease their production of proinflammatory cytokines, compared to other students who only received a placebo,” explained Kiecolt-Glaser.
“We thought the omega-3 would reduce the stress-induced increase in cytokines that normally arose from nervousness over the tests.”

The team assembled a field of 68 first- and second-year medical students who volunteered for the clinical trial. Half the students received omega-3 supplements while the other half were given placebo pills. The students were randomly divided into six groups, all of which were interviewed six times during the study. At each visit, blood samples were drawn from the students who also completed a battery of psychological surveys intended to gauge their levels of stress, anxiety or depression. The students also completed questionnaires about their diets during the previous weeks.

“The omega-3 supplement the students received was probably about four or five times the amount of fish oil you’d get from a daily serving of salmon,” explained Martha Belury, professor of human nutrition and co-author in the study.

Part of the study, however, didn’t go according to plans.Changes in the medical curriculum and the distribution of major tests throughout the year, rather than during a tense three-day period as was done in the past, removed much of the stress that medical students had shown in past studies.

“These students were not anxious. They weren’t really stressed. They were actually sleeping well throughout this period, so we didn’t get the stress effect we had expected,” Kiecolt-Glaser said.

But the psychological surveys clearly showed an important change in anxiety among the students: Those receiving the omega-3 showed a 20 percent reduction in anxiety compared to the placebo group. An analysis of the of the blood samples from the medical students showed similar important results.
“We took measurements of the cytokines in the blood serum, as well as measured the productivity of cells that produced two important cytokines, interleukin-6 (IL-6) and tumor necrosis factor alpha (TNFá),” said Ron Glaser, professor of molecular virology, immunology & medical genetics and director of the Institute for Behavioral Medicine Research.

“We saw a 14 percent reduction in the amounts of IL-6 among the students receiving the omega-3.” Since the cytokines foster inflammation, “anything we can do to reduce cytokines is a big plus in dealing with the overall health of people at risk for many diseases,” he said.

Inflammation is a natural immune response that helps the body heal, but it also can play a harmful role in a host of diseases ranging from arthritis to heart disease to cancer.

Even though the study showed omega-3 supplements can reduce both anxiety and inflammation – and some of the researchers said that they take omega-3 supplements – the researchers aren’t ready to recommend that the public start taking them daily.

“It may be too early to recommend a broad use of omega-3 supplements, especially considering the cost and the limited supplies of fish needed to supply the oil,” Belury said. “People should just consider increasing their omega-3 through their diet.”

Also working on the research with Kiecolt-Glaser, Glaser and Belury were William Malarkey, professor emeritus of internal medicine, and Rebecca Andridge, an assistant professor of public health

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Long-term efficacy and tolerability of pentosan polysulphate sodium in the treatment of bladder pain syndrome – Abstract
Tue, 19 April 2011

Urology Department, Dalhousie University, Halifax, NS.

The primary objective of this study is to report on the long-term efficacy and tolerability of pentosan polysulphate sodium (PPS) in patients with bladder pain syndrome (BPS). The secondary objective is to find the predictors of the long-term outcome.

This is a single institution, retrospective study. The study period was from 1994 to 2008. All patients fulfilled the clinical criteria of BPS, as suggested by European Society for the Study of Interstitial Cystitis. We included only patients with de novo BPS diagnosis and no previous PPS or other treatment. The efficacy of PPS was measured with the global response assessment scale (GRA). Patients were stratified into 2 groups based on the duration of the treatment. Group 1 took the drug for less than 12 months. Group 2 took the drug for more than 12 months.

There were 271 patients eligible for the study. Most of the patients were female (90%), with the mean age at presentation of 45.5 years. The average duration of symptoms was 28.5 months. The mean follow-up was 22 months (range 3-130). Out of all the patients, 147 patients (54.2%) reported over 50% improvement using the GRA. The reported efficacy was higher in Group 2 (60%). Ninety-three patients (34.3%) decided to stop taking the medication for various reasons. The most common reasons to stop the medication were poor outcome (16.6% of patients) and side effects (11.1% of patients). Poor outcome was associated with nocturia, smoking and detrusor overactivity. Good outcome was associated with longer PPS intake (>12 months) and severe cystoscopic findings of glomerulation.

Pentosan polysulphate sodium is an effective oral therapy to control the symptoms of BPS with good long-term efficacy and tolerability.
Written by:
Al-Zahrani AA, Gajewski JB. Are you the author?
Reference: Can Urol Assoc J. 2011 Apr;5(2):113-8.

Why Cats Might Need a Day at the Spa
Category: Life Science
Posted on: February 17, 2011 11:37 AM, by Dr. Dolittle

Dr. Linda Lord at Ohio State University has been studying how cats respond to stress. Her findings show that otherwise healthy cats became ill when stressed whereas cats with a disorder called feline interstitial cystitis (FIC) became healthier when they were less stressed. FIC is a painful disorder that causes inflammation of the bladder in cats and can lead to the formation of crystals that spread to the urethra.

According to the researchers, signs of stress in cats include: vomiting, decreased appetite, as well as urinating or defecating outside of the litterbox (gross!).

Cats recruited for the study were donated by pet owners who wanted to have their pets euthanized because of their illness (or to save their carpet) and had agreed to let them take part in the study first.

Dr. Lord’s group found that providing cats with an enriched environment including toys, places to hide, bedding, and a consistent daily routine, reduced and even prevented some of the signs of feline sickness showing a link between stress and illness in cats.

When the daily routines of the animals were changed, both healthy and sick cats showed increased illness that passed once the exposure to the stressful conditions ended.

The moral of the story: Happier cats make healthier cats.

31 Daily Facts About IC

1. Interstitial cystitis is not a rare condition. New epidemiological studies revealed that three to eight million women in the USA and one to four million men with IC may have symptoms of Interstitial Cystitis. That could be as many as one out of every 26 people in the USA.
2. There are various forms of “cystitis” that are easily confused. Bacterial cystitis, aka urinary tract infection, is treated with antibiotics. Radiation cystitis occurs after radiation therapy for cancer. Eosinophilic cystitis is a rare, inflammatory based cystitis. Interstitial cystitis is more of an “injury” to the bladder and/or bladder lining. Antibiotics are considered useless in the treatment of IC/BPS.
3. Up to this point, there has been no standardized protocol for the diagnosis and treatment of IC/BPS in the USA, thus clinicians have used old diagnostic methods and often ineffective therapies. Physicians must be educated about two new, vital clinical resources. In 2011, the American Urological Association released new five point treatment protocol for IC/BPS. The new UPOINT System for Clinical Phenotyping for Chronic Pelvic Pain helps physicians create a customized treatment plan. (http://www.upointmd.com).
4. The role of the pelvic floor muscles in contributing to pelvic pain is often misunderstood. Urologists often describe muscles “as tight as rubber bands” when examining interstitial cystitis patients. Patients with pelvic floor dysfunction may have difficulty starting their urine stream or feel as if something is falling out of them. Vaginal burning is a common symptom. Many IC clinics around the country now have physical therapists on staff to provide “hands on” therapy with excellent results. If a patient does not seem to be responding to bladder therapies, pelvic floor dysfunction should be considered.
5. In the past three years, ketamine bladder syndrome has emerged as a new, critical health need. Researchers around the world have documented growing numbers of young adults who present with severe urinary tract symptoms and bleeding, resulting from their use of ketamine. A recreational drug known for its dissociative anesthesia effects, ketamine has replaced heroin as the drug of choice throughout much of the world due, in great part, to its very low cost. No research has been done to determine the incidence of ketamine bladder syndrome in the USA because most physicians do not ask about drug use when presented with bladder symptoms. Physicians must be educated about the role of ketamine in triggering bladder damage. More information can be found at: http://www.ketaminebladdersyndrome.com
6. One of the easiest ways for patients to try to reduce their bladder discomfort is by removing foods which are high in acid, alcohol or salt. Even one cup of coffee day, one green tea or one soda can trigger severe bladder irritation and discomfort.
7. IC affects not only the patient but also the extended family. Parents with IC worry about their ability to support their family. Children wonder why their parent cannot attend normal daily functions, like baseball games, and often mistakenly assume that a parent is dying. Tragically, some family members and friends don’t believe that IC is a real condition and/or that the patient needs support and encouragement. Research presented at AUA 2010 demonstrated that patients with a spouse who was not supportive had a poorer outcome. The ICN has some great videos that can help educate family members. Find them at: http://www.ic-network.com/videos/
8. Some patients have had inappropriate hysterectomies only to discover, after the fact, that their pelvic pain was originating from their bladder. IC patient Angela Burch won a $2,000,000 federal medical malpractice settlement in Florida when her ob-gyn needlessly removed her healthy uterus even after the urologist reported that she had interstitial cystitis. This is not unusual. Many physicians, particularly ob-gyns, primary care or emergency room personnel, are poorly trained in the diagnosis and treatment of bladder pain patients. Educating gynecologists and primary care providers is a critical need.
9. Finding a urologist that specializes in IC is challenging. Most work in major urology clinics or hospitals affiliated with universities and conduct IC research studies on the side. One clever way of finding an IC specialist is by looking at the latest clinical trial announcements or IC journal articles. The IC Network has an online searchable database of care providers.
10. Children as young as 3 years old have been diagnosed with interstitial cystitis yet, sadly, there are no pediatric urologists in the USA who specialize in IC. This is a desperate need. If you know a urologist who enjoys working with children, please submit their name to us.
11. Pelvic pain patients may find intimacy uncomfortable at times. Men with IC may feel discomfort at the moment of ejaculation while women report their most intense discomfort in the 24 hours after sex. Having an “after sex” routine to reduce muscle tension can be helpful, including using heat, warm bathes and, possibly, a muscle relaxant. Vaginal valium suppositories help reduce painful pelvic floor spasms. A new book, Secret Suffering: How Women’s Sexual and Pelvic Pain Can Affect Their Relationships, may help.
12. Approximately 5% of IC patients have Hunner’s Ulcers. These larger, bleeding wounds in the bladder can be very painful. Treatment of these ulcers usually involves laser therapy, fulguration (heat) and/or the injection of a steroid, triamcinolone, into the center of the ulcer. These ulcers can recur in the same location and may require a few treatments.
13. Does your IC flare when you’re having bowel discomfort? In the September 2008 article, Pepperoni Pizza: How the bowel can trigger bladder pain, researchers found that when the bowel becomes irritated, the bladder shows signs of irritation as well. Perhaps this explains why IBS and IC patients both avoid caffeine, a well known neurostimulant.
14. Surgery is rarely considered for the treatment of IC and only after a patient has tried and failed ALL of the easier therapies, including oral medications, bladder instillations, some experimental therapies (i.e. botox). A bladder augmentation can help increase bladder capacity by using a section of the bowel to enlarge the bladder. An excellent resource and reference guide for IC treatments, including surgery, is the book “The Interstitial Cystitis Survival Guide” by Robert Moldwin MD.
15. Patients with more severe IC who are unable to work may apply for disability benefits. There are several different disability programs available depending upon your state. State disability is usually short term disability with the goal of helping you return to work. Federal disability programs, such as SSA or SSI, require that you be unable to work. While Social Security Disability is notorious for denials at the application stage for all disabilities, patients can (and should) appeal their decisions and often win benefits. A voiding diary serves proof of bladder symptoms and should be submitted with other evidence supporting your claim of disability. Learn more about disability programs in the ICN Disability Resource Center.
16. IC patients often experience their most uncomfortable symptoms at night when distractions are fewer and they notice their bladder symptoms more. They may feel a constant need to urinate or an uncomfortable sensation of bladder fullness that is very difficult to ignore. Night time discomfort often relates to foods eaten during the day that irritate the bladder. Taking a warm shower or using a heating pad can help improve sleep quality. Some medications may also be helpful.
17. IC patients should keep track of their diagnostic tests, treatments and physician appointments so that they can clearly discuss their history with new physicians. There’s nothing worse than being asked “what treatments did you try?” and to respond “I don’t know.” That’s unacceptable. You must track your treatments. ICN Medical Records Kit.
18. Before allowing any instillation placed into the bladder, a wise patient will ask “What is it?” “How does it work,” “When will I know if it’s helping?,”"What are the risks or benefits?” Several instillations are now rarely used, including: clorpactin, silver nitrate, BCG or RTX. Find more questions to ask in the ICN Exploring IC Treatments Guide.
19. It’s not unusual for patients to choose between buying food and/or medication. Many simply cannot afford to pay for treatment. Luckily, most IC medications are available through their manufacturers drug assistance programs. A list can be found in the ICN Drug Assistance Center.
20. Many patients find sitting for long periods of time to be uncomfortable, especially in a car, on a bus or on a plane. When travelling, try to break up long car or bus rides into smaller segments. Cars with a smooth suspension, such as larger sedans or SUV’s, are usually much more comfortable for IC patients to drive in. If you struggle with anxiety over finding a restroom, consider carrying some TravelJohns with you. These can be used in a pinch when a restroom isn’t easily available. IC friendly chair cushions might make trips more comfortable.
21. IC patients often struggle with anxiety symptoms. The new UPOINT System for the Clinical Phenotypes for Chronic Pelvic Pain assesses for anxiety disorder and encourage patients to seek treatment. Many local hospitals provide affordable anxiety management classes that, in a few short weeks, can teach essential coping skills. The ICN offers a video on anxiety and IC.
22. A bladder instillation uses a catheter to deliver medication through the urethra and into the bladder. A small pediatric catheter is often used to minimize discomfort. Slippery “hydrophilic” catheters (i.e. such as the AstraTech Lo Fric catheter) are generally easier to insert and remove than dry catheters. Learning to self catheterize is easy and can be very liberating for IC patients who can then perform bladder instillations at home.
23. IC support groups exist throughout the world and USA. Use the ICN Support Center to find one near you. If you can’t find one close to you, you can participate in live support group meetings over the web, all from the comfort of your home. Please consider starting a support group in your town if one is not present.
24. Cranberry products are well known for triggering irritation in an IC bladder, as well as many other fruit juices and products. Fruits high in acid should be avoided such as oranges, grapefruits, lemons and limes. Fruits that are considered more IC friendly are pears, mild sweet apples, blueberries and more. Find more diet tips in the 2009 IC Food list.
25. Botox is one of several experimental therapies currently in use in urology clinics. Botox can be injected into the bladder wall where it deactivates the nerves that trigger some bladder symptoms. It can be hard to find a clinician who uses botox therapy. Most major urology clinics and universities may have it avalable.
26. One of the most promising new therapies under development is the use of liposomes. Led by Dr. Michael Chancellor (William Beamont Hospital, Royal Oak MI), liposomes can be used to deliver medication into the bladder (i.e. such as botox) but some research has shown that the empty liposome itself can be helpful. This research is new, exciting and still evolving and is yet one more reason why we support making donations to this vital IC research center.
27. IC patients report that wines and beer often trigger IC flares, though the types of wines and beers make a difference. Low acid wines, such as chardonnay, and pale ales, such as Blue Moon, appear to be the best tolerated. Surprisingly, straight alcohols were also more tolerated. Read more about it.
28. Planning a pregnancy when you have interstitial cystitis can be challenging but is very doable. Some patients symptoms disappear during pregnancy while other patients may notice that their symptoms worsen. Medication use must be discussed carefully with your physician. Luckily, IC researcher Deborah Erickson has written a wonderful research article that can help. Read more in the ICN Pregnancy Resource Center.
29. IC patients may be afraid to eat for fear of irritating their bladders further. Take heart. There are many bladder friendly foods that can be enjoyed. The secret is to start with fresh, healthy foods rather than fast or junk food. The 2009 IC Food List breaks foods into three categories and lists foods that are IC friendly, foods that are worth trying and foods that should be avoided. Read it now in the ICN Diet Center.
30. A rescue instillation, composed of heparin, lidocaine and other ingredients, is one of the most popular therapies in use today for IC because it can help to numb the bladder and provide a protective coating. There are many formulas currently in use. Read more in the ICN Rescue Instillation Guide.
31. Neuromodulation, aka sacral nerve stimulation, is not FDA approved for the treatment of IC though it has been used in many clinics to help control urinary frequency. This therapy requires careful thought and consideration. There is a trial phase which, if succesful, can lead to a permanent implant. The device, however, also has thousands of adverse event reports filed with the FDA ‘s Maude Database, including MRSA infection, device malfunction, lead migration, pain at the implant site and, sadly, some fatalities. Neuromodulation devices require life long medical care and can result in multiple surgeries over time. Read more in the ICN Neuromodulation Center.