Spinal Cord Stimulation for the Treatment of Persistent Pain
What is spinal cord stimulation?
A spinal cord stimulator is a pacemaker-like device that acts by sending electrical impulses to the spine to block pain signals from reaching the brain. Generally, spinal cord stimulation is useful in the treatment of chronic pain or pain that is persistent even after other treatments like surgery. SCS can often be a useful treatment for sufferers of chronic pain because the significant relief of pain can improve quality of life drastically. There are different types and intensities of spinal cord stimulation such as Burst DR stimulation, high-frequency stimulation (HF-10), Dorsal Root Ganglion (DRG) stimulation, and Illumina 3D stimulation.
What does it treat?
Generally, spinal cord stimulation is a viable option when a patient is experiencing significant pain that has not seen improvement with other treatments. Often, this includes surgery. Even more, a good candidate for SCS will probably not benefit from additional surgery and need only reduce the chronic pain. Specific conditions that SCS helps include:
- Failed back surgery syndrome (post-laminectomy syndrome)
- Complex regional pain syndrome (reflex sympathetic dystrophy)
- Lumbar radiculopathy (sciatica)
- Cervical radiculopathy (arm pain)
- Low back pain from degenerative disc disease or spondylosis
- Spinal stenosis
- Multiple sclerosis related pain
- Leg and foot pain
- Pain after hernia repair
- Thoracotomy related pain
- Post-herpetic neuralgia (shingles pain)
- Pain after amputation – stump pain or phantom limb pain
- Pain from spinal cord injury
The trial period.
Before a spinal cord stimulator is implanted into the body, a trial period is given to assess if the patient is a good candidate for the stimulator. During this trial, rather than implanting a larger stimulator, electrodes are temporarily placed in the body that produce stimulation. These electrodes are left in place for 3-7 days. During this time, the system will work exactly like an implanted system, but without any incisions or surgery. At the end of the trial period, the patient’s doctor will evaluate the patient for their candidacy for implantation. If the patient saw a decrease in pain during the trial, they will make an appropriate candidate for the surgical implantation. If not, the temporary electrodes are easily removed and other treatment plans may be discussed.
If the surgeon determines that the patient is a good candidate for implantation, they will schedule an outpatient surgery. During this relatively straightforward procedure, the surgeon will make a small incision so that they can place the leads under the skin. Then, they will make a second incision for the battery. The surgeon will make these incisions just below the waistline to remain inconspicuous. They will then connect the leads to the battery and close up the incisions. (Yes, it really is that easy.)
The common goal and reported pain relief for patients undergoing spinal cord stimulation is anywhere between 50-70% reduction in pain. For those suffering chronic pain, this reduction can be tremendous in terms of returning a patient to their normal life. Even for those receiving less of a pain reduction, most report that they experience enough pain relief to return to daily activities and get on with their life.
When paired with a small amount of pain medication, too, some patients are able to almost completely reduce their experience of pain. As the outpatient implantation is relatively easy, most patients can return to work in only 3-5 days. The incisions heal after about 2 weeks and can return to bending/twisting after 4-6 weeks. A patient may resume full activity, generally, after 8 weeks. Compared to most back surgeries and other treatment plans that address the conditions listed above, spinal cord stimulation is a relatively, low-risk treatment for sufferers of chronic pain.