Spinal Cord Stimulator (trials and implants)

Spinal Cord Stimulator (trials and implants)

Spinal cord stimulation (SCS) is an innovative technology that uses a mild electric current to relieve chronic pain of the back, arms and legs. The treatment involves implanting a small device (neurostimulator) into the back of the spine where it can send electrical impulses (via a small wire) to the nerves in the spinal cord that are causing pain. The pulse created by the neurostimulator stimulates the nerves and blocks the pain signal, preventing messages of pain from reaching the brain. Instead of pain, the patient feels a tingling sensation.

SCS does not treat or repair the underlying cause of the pain (such as damaged nerves ) and can’t totally eliminate the pain. Instead, SCS decreases the patient’s perception or feeling of that pain. In general, doctors are able to achieve a 50 to 70 percent reduction in pain with spinal cord stimulation. When a patient has been intensely hurting for many months, that level of pain reduction can significantly improve his or her quality of life.

Who is a good candidate for SCS?

Dr. Sonia Pasi offers spinal cord stimulation to select patients at Advanced Pain Consultants. Typically that means patients with chronic and severe neuropathic pain, who have not responded to other types of treatment. Neuropathic pain is pain emanating from damaged nerves, and occurs when there is disease, trauma or injury to the central nervous system (spinal cord) or peripheral nervous system (any nerves outside of the spinal column). Neuropathic pain is usually described as sharp, stabbing, shooting, tingling or burning.

Patients selected for a SCS procedure usually have experienced at least six months of severe neuropathic pain in their back, neck, arms or legs. SCS is not a “first line” treatment and is only used when all other methods of pain control have failed or are not tolerated by the patient.

An SCS can help lessen chronic neuropathic pain caused by:

  • Leg (sciatica) or arm pain.
  • Post-laminectomy syndrome (Failed back surgery syndrome).
  • Complex regional pain syndrome (a progressive disease of the nervous system).
  • Arachnoiditis (inflammation and scarring of the protective layers of the spinal nerves).
  • Spinal cord injuries.
  • Peripheral neuropathy (damage to the peripheral nerves).

As with most medical treatments, SCS may not be recommended for everyone. Individuals who are taking blood-thinning medication (e.g. Coumadin and injectable Heparin), have a implanted defibrillator or pacemaker, or suffer from significant psychological problems are not candidates for this device. Patients with an active infection should wait until they are over the illness before starting this procedure.

If you are interested in SCS, Dr. Pasi will want you to come in for an evaluation. She will conduct a comprehensive physical examination, which will include an assessment of your health history and a review of past pain treatments (medication, physical therapy, injections, and surgeries). This will help Dr. Pasi determine whether SCS can meet your pain management goals.

How Does SCS Work?

Spinal cord stimulation is a two-stage procedure. The first stage is called the trial stage. The purpose of the trial is to evaluate the effectiveness of the various stimulation settings, and determine if the SCS is beneficial for the patient. This procedure is done in-office under local anesthesia. Using a specialized needle, Dr. Pasi will insert one or two insulated lead wires into the epidural space (the area between the spinal nerves and bony vertebrae). These wires will be attached to an external stimulator device, which will be worn on a belt or pack. Once the stimulator is in place, the patient returns home for a trial period. This will allow him or her time to “test out” the stimulator and see how it does at relieving pain.

After about a week, the patient returns to our medical offices for a follow-up visit with Dr. Pasi to evaluate the effectiveness of the trial. Generally, if the stimulator produced at least a 50 percent reduction in pain, the trial was successful. If that is the case, then Dr. Pasi will move forward with the second stage of the procedure: the permanent placement of the SCS system. This is may be done one or two weeks after the trial stage is completed.

The permanent implant is inserted under general anesthesia. Dr. Pasi removes the previously-inserted lead wires and new leads are inserted into the epidural space. The ends of these leads are attached to a permanent stimulator (known as an “implantable pulse generator”) that is implanted in a small pocket created under the skin in the abdomen or buttocks.

At the end of the procedure, the device is tested to make sure it still produces the same benefits for the patient. Patients return home from the surgery with an external control unit which enables them to turn the current on and off, or adjust the intensity, depending on the severity of the pain (which may fluctuate from day to day).

What are the results?

Spinal cord stimulation is not effective with every patient, but it does show good-to-excellent long-term relief in 85 to 90 percent of those who have undergone treatment. In most cases, patients experience pain relief as soon as their initial trial systems are in place. With other patients, leads must be adjusted (after the trial, when the permanent system is implanted) in order to achieve optimum pain relief and coverage of the painful area.

Many patients report a positive effect on their mental outlook and a significant increase in their ability to enjoy daily living. They feel better when they’re with family and friends, can participate in recreational and leisure activities, and even return to work (if they had previously gone on disability due to pain). Even then, SCS does not cure the condition that is causing the pain, but rather helps patients tolerate the pain. The severity of chronic pain is reduced to a more manageable level. Many patients also report a decreased need for pain medication with SCS.

The battery within the permanent stimulator is long-lasting, but may need to be replaced after five years or so, at which time a new battery may need to be inserted through another surgery. It’s also important to understand that although the SCS system is considered a “permanent” treatment, it is reversible. If this type of pain treatment is no longer needed or desired, the implanted leads and stimulator can be easily removed.

For more information

If you suffer from chronic neuropathic pain, spinal cord stimulation (SCS) may enable you to effectively control and relieve your pain. To learn more about this treatment method or to schedule a consultation, please call Advanced Pain Consultants at (919) 510-7901 to book your appointment. Dr. Pasi can determine if SCS or another method of pain relief is the best option for you.