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REN* – Remote Electrical Neuromodulation
Remote electrical neuromodulation (REN) is an innovative treatment that involves stimulating the peripheral nerves in the upper arm to trigger conditioned pain modulation. This endogenous analgesia mechanism works by using conditioning stimulation to inhibit pain in distant areas of the body, such as the head. NerivioTM is a wireless, wearable, battery-operated REN device that is controlled via a smartphone application.[1]
The NerivioTM device stimulates the C and Aδ nociceptive fibers on the upper arm. The intensity is required to be above
the depolarizing threshold but below the perceived pain threshold. The information reaches the brainstem pain
regulation centre through the ascending pain pathway (illustrated in black). This then activates the descending pain
inhibitory pathway (shown in green) which includes the periaqueductal gray, rostral ventromedial medulla and
subnucleus reticularis dorsalis. The resulting release of serotonin and noradrenaline inhibit incoming messages of pain in the trigeminal cervical complex that occur during migraine. [2]
References
1. McVige J, Stark-Inbar A. Remote Electrical Neuromodulation for the Acute Treatment of Episodic and
Chronic Migraine. touchREVIEWS in Neurology. 2021;17(1):6–10
2. Yarnitsky D, Dodick DW, Grosberg BM, et al. Remote Electrical Neuromodulation (REN) Relieves Acute
Migraine: A Randomized, Double-Blind,
Placebo-Controlled, Multicenter Trial. Headache 2019;59:1240-1252
