Neuromodulation Technologies: Whom Do We Serve?

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Journal Article

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This chapter focuses on the various scientific, technological, humanistic, ethical, and economic aspects of applying neuromodulation technologies. The neuromodulation encompasses various technologies including neurostimulation, neuroaugmentation, neural prosthetics, and functional electrical stimulation (FES). Neuromodulatory devices are used for a growing number of indications including pain (ischemic, visceral, and neurogenic), angina pectoris, peripheral vascular disease, epilepsy, urinary disorders, spasticity from spinal cord injury, cerebral palsy, or multiple sclerosis, and diabetes. Some of the psychiatric disorders that have to be carefully considered before comprehensively assessing the patients include anxiety, depression, psychosis, and somatoform disorders. Such patients may have difficulty expressing their feelings directly or even recognizing them and so, if the physician can respond to the underlying feelings, it may be easier than responding to the behavior itself. Ideally everyone who could benefit from these or other treatments should have access to them. Unfortunately, the uninsured or underinsured population has very limited opportunity for benefiting from expensive neuromodulation techniques. Individuals who are at the end stage of their lives and could potentially benefit from neuromodulation are often passed over as undeserving of this opportunity for relief because of the costs incurred for little time left. As with so many ethical issues, value is often calculated as a cost-benefit analysis. © 2009 Elsevier Ltd All rights reserved.

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