Remedius ExStimPro is a modern, non-invasive method of peripheral neuromodulation enabling treatment of neuropathic and chronic pain without the need for implantable stimulators. The technology developed by London-based pain medicine specialist Dr Teodor Goroszeniuk is used in leading pain clinics across the United Kingdom and Europe.

What is External Peripheral Neuromodulation (External PNS)?

Neuromodulation is a modern branch of pain medicine in which precisely calibrated electrical impulses modify the way peripheral nerves and the central nervous system conduct and process pain signals. Classical peripheral neuromodulation (PNS – Peripheral Nerve Stimulation) requires subcutaneous electrode implantation – Remedius ExStimPro achieves a similar effect entirely non-invasively, through a special pen-shaped skin electrode (Stimulating PEN) or surface electrodes.

Mechanism of Action – How Does ExStimPro ‘Switch Off’ Pain?

  • Gate control theory of pain (Melzack-Wall) – stimulation of Aβ fibres (fast sensory) closes the ‘gate’ in the dorsal horn of the spinal cord to pain impulses from Aδ and C fibres (slow, pain)
  • Aδ fibre fatigue – repeated stimulation causes transient ‘fatigue’ of peripheral pain fibres and reduces their ectopic discharges
  • Modulation at the level of the dorsal root ganglion (DRG) – effect on the first pain synapses
  • Activation of central structures – lateral prefrontal cortex, sensory cortex, anterior cingulate cortex, hippocampus – modulation of pain perception at cortical level
  • Induction of neuroplasticity – long-term ‘remodelling’ of pathological pain pathways
  • Stimulation of endogenous opioid release and reduction of local inflammatory mediator activity

What Distinguishes the Remedius ExStimPro Device?

  • Narrow low-frequency stimulation beam with adjustable intensity – allows precise localisation of the nerve responsible for pain (also functions as a diagnostic test)
  • Dual function – external PEN electrode (to skin) or electrode for minimally invasive stimulation (e.g. transurethral stimulation catheter for pelvic pain, or intranasal catheter for sphenopalatine ganglion stimulation in head and facial pain)
  • Portable, compact device – enabling continuation of therapy at home after training
  • Electrical shielding – metal dome of the PEN concentrates the impulse at a single point
  • High build quality – device manufactured in Poland for the UK and EU markets
  • Often avoids the need for neuromodulation implant surgery or defers that decision

Indications for ExStimPro Neurostimulation

  • Trigeminal neuralgia and other facial neuralgias
  • Neuropathic limb pain (following peripheral nerve injuries, in diabetic polyneuropathy)
  • Sphenopalatine ganglion pain syndrome (cluster headaches, facial pain)
  • Chronic migraine (as a complement to botulinum toxin therapy)
  • Chronic pelvic pain (in women and men) – transurethral bladder neuromodulation, pudendal neuralgia
  • Post-surgical neuropathic pain
  • Complex Regional Pain Syndrome (CRPS)
  • Phantom pain after amputations
  • Identification and localisation of neuropathic pain source (diagnostic mode)

Procedure Sequence

  • Consultation with a pain medicine physician, assessment of pain character and qualification for neuromodulation.
  • The first session often has a diagnostic character – the physician localises the point where stimulation brings maximum relief. This point becomes the therapeutic target.
  • The actual therapeutic session lasts 20–30 minutes. The patient sits or lies down while the physician guides the PEN electrode along the skin in the nerve area, adjusting stimulation parameters (frequency, intensity).
  • The patient typically experiences gentle tingling or a vibration sensation – pain gradually subsides during the session.
  • Schedule: typically 6–8 sessions at 1–2 week intervals; patients with a very good effect may receive maintenance therapy at home.
  • In transurethral neuromodulation, a special stimulating catheter set is used (minimally invasive technique).

Preparation

  • No need to fast
  • Normal skin hygiene in the stimulation area
  • The physician should be informed of all medications being taken (especially those affecting the central nervous system)
  • Absolute contraindication: cardiac pacemaker, cardioverter-defibrillator, other active electronic implants (especially in the planned stimulation area)
  • Contraindication: epilepsy, pregnancy (relative)

Effects

  • First effects often felt during the very first session
  • Full effect: after 4–6 sessions – visible cumulative improvement
  • Duration of effect: from several weeks to many months, depending on the condition
  • Possibility of long-term maintenance therapy without risk of tolerance (unlike pharmacotherapy)
  • In some patients, analgesic medications can be significantly reduced or discontinued entirely
  • Efficacy is a good predictor of implanted PNS effectiveness – if external stimulation works, the implant will most likely also work

Possible Side Effects

  • Very rare and mild – the primary advantage of the technology
  • Transient skin irritation at the electrode contact site
  • Increased sensitivity of the stimulation area for a few hours after the session
  • No risk typical of invasive procedures (infection, haematoma, nerve damage)

FAQ

How does ExStimPro differ from TENS?

TENS (Transcutaneous Electrical Nerve Stimulation) is general surface stimulation with a broad range of action. ExStimPro is precise, targeted neuromodulation of a specific nerve or area – with adjustable parameters tailored to the anatomical structure. It is a physician-operated tool, not a self-rehabilitation device.

Can ExStimPro replace implantable neuromodulation (SCS/PNS)?

 In some patients yes – if external neuromodulation provides satisfactory relief, an implant is not needed. In others ExStimPro serves as a qualifying test: a good response to external stimulation is a strong argument for the effectiveness of an implant.

Can I use the device at home?

After a cycle of clinic sessions and appropriate training, some patients receive recommendations for maintenance therapy at home using a simpler version of the device (Remedius ExStim).