Axomera – Neuromodulation for pain (DE/EN)

What is Axomera? Neuromodulation in orthopedics

Axomera is a neuromodulatory treatment approach that delivers weak, precisely controlled electrical impulses via a fine needle electrode close to nerves, tendon attachments or painful soft tissue structures. In contrast to medication injections, no active ingredient is injected; it is not an operation.

The procedure is one of the percutaneous neuromodulation techniques (similar to PENS/PNT). The treatment takes place on an outpatient basis, in a local environment without anesthesia. Many people affected feel a slight tingling sensation or rhythmic impulses.

• Goal: Modulation of pain conduction and neurogenic inflammation
• Setting: outpatient, minimally invasive, without systemic medications
• Role: Complementary to physiotherapy, load control and other conservative procedures

How it works: How neuromodulation can influence pain

Pain is a complex interplay of peripheral stimuli (e.g. from tendons or fascia), nerve conduction and processing in the spinal cord and brain. Neuromodulation aims to temporarily influence these signaling pathways - with the aim of dampening excessive pain activity and supporting local regulatory processes.

• Peripheral level: Irritation of pain-conducting nerve fibers is modulated.
• Segmental level: Spinal cord reflexes and gate control mechanisms can be influenced.
• Regional tissue response: Electrical stimulation can modulate tissue metabolism and microvascular processes.

Differentiation from other procedures:

• TENS: transcutaneous surface stimulation via adhesive electrodes; less focused.
• PENS/PNT: similar percutaneous procedures; Axomera is a brand-specific implementation.
• Shock wave (ESWT): mechanical stimulation therapy; no electrical stimulus.
• Injections/PRP: pharmacological/biological approaches; other operating principles.

Who can Axomera be suitable for?

The selection is made individually depending on the diagnosis, duration and severity of the symptoms as well as whether conservative measures have already been exhausted. Typical application scenarios in orthopedics/sports medicine:

• Tendinopathies and insertion tendinoses (e.g. Achilles tendon, tip of the patella, gluteal tendons, proximal hamstring)
• Epicondylopathies (tennis and golfer's elbow)
• Plantar fasciitis/plantar heel pain
• Painful myofascial trigger points
• Reactive nerve irritation near the soft tissue (e.g. Morton's neuroma-like symptoms; careful clarification required)
• Persistent pain after strain/sprain without structural rupture

Not all types of pain are suitable. In the case of acute complete tears, significant neurological deficits, infections or unexplained warning signs, a different diagnosis/treatment is the priority.

Contraindications and caution

For safety reasons, Axomera is not suitable for all people and situations.

• Pacemaker/ICD or other implanted electrical devices: only after individual cardiology consultation or as a rule not
• pregnancy
• coagulation disorders; Taking strong anticoagulants (case-by-case review)
• Acute infection or skin injury in the treatment area
• Unclear, unexplained pain with warning signs (e.g. fever, pain at night when resting, pronounced neurological deficits)
• Allergy to materials used

In the case of metal implants in the region, severe sensory impairment or epilepsy, special caution is required and an individual risk-benefit assessment is required.

Evidence: realistically classify opportunities

There are growing but heterogeneous studies for percutaneous neuromodulation - often smaller controlled studies, prospective registries and case series. Observational data are also available for specifically branded protocols. Overall, the data indicate possible relief in selected pain syndromes, but the effects are not reproducible in all patients.

• No universal effectiveness, no guarantee of freedom from symptoms
• Partial short to medium term relief described; Long-term data limited
• Guidelines do not list percutaneous neuromodulation as standard first-line therapy everywhere
• Safety is good when used professionally, relevant complications are rare

Our approach: evidence-based, transparent, conservatively prioritized. Neuromodulation is an option when basic measures are not sufficient or there are specific reasons for a focused stimulus.

Process of treatment in our practice

1. Diagnosis & information: anamnesis, examination, if necessary ultrasound/further diagnostics; Weighing alternatives.
2. Define target point: Marking of the pain-relevant structure, often with ultrasound support.
3. Sterile procedure: Disinfection, fine needle electrode is placed near the target.
4. Stimulation: protocols with low currents/impulses, usually lasting 10-30 minutes; Sensation as tingling/slight twitching.
5. Follow-up: Short-term monitoring, discussion of aftercare and activity development.

Number of sessions: In many cases 1-3 sessions spaced 1-2 weeks apart. Depending on the course, adjustments may make sense. The treatment is embedded in an individual therapy concept (physiotherapy, home exercises, stress control).

After treatment: behavior and course

• Slight protection on the day of treatment, usually usable for everyday use from the following day onwards
• Temporary tenderness or muscle soreness-like symptoms possible
• Local cooling if necessary, stimulus-adapted activity program
• Warning signs: increasing redness, severe pain, fever or numbness - please seek medical advice

If there is an improvement, many patients report initial changes within days to a few weeks. Individual reaction varies.

Useful combinations with conservative procedures

Neuromodulation often unfolds its potential within the framework of a multimodal concept. The following have proven themselves:

• Physiotherapy and targeted exercises (eccentrics, isometric training, strength building)
• Load control in sports/everyday life, ergonomic adjustments
• Manual therapy, fascia treatment, taping
• Shock wave therapy (ESWT) if indicated
• Acupuncture (TCM) as a pain-relieving supplement

Medications such as NSAIDs can provide short-term support, but should be used appropriately and carefully.

Side effects and risks

• Hematoma/bruise, temporary local pain
• Tingling, muscle twitching during the session
• Short-term dizziness or vasovagal reaction
• Very rare: infection, persistent nerve irritation, vascular injury
• Allergic reaction to disinfectants/materials

Complications are rare, but can never be completely ruled out. A professional indication and sterile technique reduce risks.

Costs & Reimbursement

Axomera/neuromodulation is often a self-pay service in Germany. Statutory health insurance companies generally do not cover the costs. Private insurance companies reimburse depending on the contract and individual case; billing is carried out analogously according to GOÄ.

You will receive transparent information in advance about the expected costs and the expected number of sessions.

Axomera neuromodulation – short overview (EN)

Axomera is a percutaneous neuromodulation approach using fine needle electrodes to deliver low-intensity electrical stimulation close to pain-generating structures. The aim is to modulate peripheral pain signaling and neurogenic inflammation.

• Potential indications: tendinopathies (Achilles, patellar, lateral epicondylitis), plantar fasciitis, myofascial pain, selected nerve irritations.
• Outpatient procedure; usually 1-3 sessions, 10-30 minutes each.
• Safety: mostly minor, transient side effects; Serious complications are rare but possible.
• Contraindications: pacemaker/ICD, pregnancy, infection at the site, relevant coagulopathy.
• Evidence is evolving; results vary. It complements physiotherapy and load management.
• Coverage: often self-pay in Germany; private insurance may reimburse depending on policy.

Alternatives and when Axomera does not make sense

Before neuromodulation, conservative standard measures are exhausted where appropriate: structured physiotherapy, exercise programs, activity adjustment, if necessary shock waves, acupuncture or time-limited drug options.

• Acute complete tendon rupture, severe instability: other procedures are primarily required
• Unclear, progressive symptoms with red flags: imaging/laboratory diagnostics first
• Primarily neuropathic generalization patterns or severe central pain syndromes: check other therapy concepts

Location & date in Hamburg

Practice address: Dorotheenstraße 48, 22301 Hamburg. Please bring any existing findings (doctor's reports, imaging) with you to the appointment. After the examination, we will discuss whether Axomera is an option for you as part of a conservative overall concept.

The 5 tips at a glance

1. Goal: Modulation of pain conduction and neurogenic inflammation
2. Setting: outpatient, minimally invasive, without systemic medications
3. Role: Complementary to physiotherapy, load control and other conservative procedures
4. Peripheral level: Irritation of pain-conducting nerve fibers is modulated.
5. Segmental level: Spinal cord reflexes and gate control mechanisms can be influenced.

Information does not replace an individual examination. If there are any warning signs, please seek medical advice.