Spinal Cord Stimulation Therapy: A Breakthrough Approach for Chronic Pain Management
Spinal cord stimulation (SCS) therapy masks pain signals before they reach the brain. A small device, similar to a pacemaker, delivers electrical pulses to the spinal cord. It helps people better manage their chronic pain and reduce their use of opioid medications. It may be an option if you suffer chronic back, leg or arm pain and have not found relief with other therapies. Published studies of spinal cord stimulation show good to excellent long-term relief in 50 to 80% of patients suffering from chronic pain. SCS is a well-established approach to managing chronic pain used globally for over 30 years. More than 30,000 people annually undergo surgery to implant a spinal cord stimulator.
What Is A Spinal Cord Stimulator?
A spinal cord stimulator device is surgically placed under your skin and sends a mild electric current to your spinal cord. Thin wires carry current from a pulse generator to nerve fibers of the spinal cord. SCS alters the way you experience pain by sending impulses to the spinal cord that compete with pain signals. As a result, the pain messages that your body sends to the brain are blocked or modified. The goal for SCS is to have over a 50% reduction in pain. However, even a small amount of pain reduction can be significant if it helps you perform daily activities and reduces the amount of pain medication you take. On average patients experience 76% reduction in pain.
Who Are Potential Candidates?
An evaluation of your physical condition, medication regime, and pain history will determine whether your goals of pain management are appropriate for SCS. A neurosurgeon, physiatrist, or pain specialist will review all previous treatments and surgeries. Because chronic pain also has emotional effects, a psychologist will assess your condition to maximize the probability of a successful outcome. Patients selected for SCS usually have had chronic debilitating pain for more than 6 months in the lower back, leg (sciatica), or arm. You may be a candidate for SCS if: Conservative therapies have failed. You would not benefit from additional surgery. You do not want further surgery because of the risks or long recovery. Sometimes SCS may be chosen over a large, complex spine surgery.
An SCS Can Help Lessen Chronic Pain Caused By:
Chronic leg (sciatica) or arm pain: ongoing, persistent pain caused by arthritis, spinal stenosis, or by nerve damage. Failed back surgery syndrome: failure of one or more surgeries to relieve persistent leg or arm pain, but not a technical failure of the original procedure. Non-surgical refractory back pain, when you are not a candidate for back surgery. Complex regional pain syndrome: a progressive disease in which patients feel constant, chronic burning pain, typically in the foot or hand. Arachnoiditis: painful inflammation and scarring of the protective lining of the spinal nerves. Other: stump pain, angina, peripheral vascular disease, multiple sclerosis, or spinal cord injury. Painful diabetic neuropathy; for patients whose pain is refractory to, or who can’t tolerate, conventional medical treatment.
Who Performs The Procedure?
Neurosurgeons and doctors who specialize in pain management (an anesthesiologist or physiatrist) implant spinal cord stimulators. The surgical decision Determining whether a spinal cord stimulator will be a good option for you is a two-step process.
Stage 1. Temporary Trial
First, you must undergo a temporary trial to see if the device decreases your level of pain. The trial or “test drive” is performed to determine if an SCS will work for the type, location, and severity of your pain. It is performed at an outpatient center, or office based surgery suite. If you take blood-thinners, you are required to stop the medication 3 to 7 days prior to the trial. A local anesthetic is given to numb the area in the lower back. Using X-ray fluoroscopy, a hollow needle is inserted through the skin into the epidural space between the bone and spinal cord. The trial lead is inserted and positioned over specific nerves. The wires are attached to an external generator which is just taped to your skin. Procedure is around 30 minutes. A representative will follow up with you daily and its important to take note how the stimulator helps with pain, sleep, function, and need for pain medication. After 5 to 7 days, you will return to the doctor’s office to remove the trial leads, and discuss if you would like to move forward with the implant.
Stage 2. Surgical implant
If the trial is successful and you felt greater than 50% improvement in pain and improvements in sleep and/or function then surgery can be scheduled to implant the SCS device in your body. During the minimally invasive procedure, your doctor will place the device, similar in size to a pacemaker, under your skin. The implant is placed in your lower back or buttocks area; you and your doctor will decide which location will be most comfortable for you. The implant procedure typically takes up to two hours and is performed with anesthesia or sedation to make it as comfortable as possible. You’ll typically go home the same day and you will need to bring someone with you to drive you home. Like other minor surgical procedures, complications can include anesthetic risks, infection, poor wound healing, and pain at the procedure site. These types of events are generally expected with any kind of procedure, and almost all of them are resolved on their own or with medication within a few weeks or months. Most complications are mild or temporary but in extremely rare cases can cause serious injury or death.
After The Implant
It’s possible you may experience complications after the device is implanted, which can include loss of pain relief, lead migration, allergy, and pain or uncomfortable stimulation from lead migration. These complications can be resolved by reprogramming the device, medical treatment, corrective surgery, or removing the device. The recovery period is about 4-8 weeks. During this time, you should engage only in light activity while you recover and avoid lifting items that weigh more than 5 pounds, twisting, bending, climbing, stretching and any movement that involves reaching over your head. With your doctor’s approval, generally, after your recovery period you can do things like swim, travel, and return to the activities you love. Spinal cord stimulators are covered by nearly all major insurance plans, including Medicare and Medicaid.
Written By: Ben Klass
