Apparatus and methods for
managing pain uses separate varying electromagnetic fields, with a variety of temporal and amplitude characteristics, which are applied to a particular neural structure to modulate glial and neuronal interactions as a mechanism for relieving
chronic pain. In another embodiment, a single composite modulation / stimulation
signal which has rhythmically varying characteristics is used to achieve the same results as separate varying electromagnetic fields. Also, disclosed is an apparatus and method for modulating the expression of genes involved in diverse pathways including inflammatory /
immune system mediators,
ion channels and neurotransmitters, in both the
Spinal Cord (SC) and
Dorsal Root Ganglion (DRG) where such expression modulation is caused by
spinal cord stimulation or
peripheral nerve stimulation using the disclosed apparatus and techniques. In one embodiment of multimodal modulation therapy, the prime
signal may be monophasic, or biphasic, in which the polarity of the first phase of the biphasic prime
signal may be either cathodic or anodic while the tonic signal may be either monophasic, or biphasic, with the polarity of the first phase of the biphasic tonic signal being either cathodic or anodic.