For people suffering from some types of chronic pain, a treatment called spinal cord stimulation (SCS) may hold the key to relief. Referred to by some experts as a “pacemaker for pain,” spinal cord stimulation for chronic pain is now a widely accepted treatment for pain. For some patients, success rates are as high as 75%.
What are the conditions treated with spinal cord stimulation for chronic pain?
Spinal cord stimulation is a treatment that involves sending low-voltage electrical currents to the spinal cord and the nerves sending pain signals. This process halts the pain signals and alleviates discomfort. Spinal cord stimulation can be used for a multitude of pain conditions and symptoms, especially those related to nerve pain or damage. The most common conditions treated with spinal cord stimulation include:
- Chronic pain related to nerve damage
- Peripheral neuropathy
- Complex regional pain syndrome (CRPS), a condition resulting from injured or improperly functioning nerves
- Failed back surgery syndrome
- Phantom limb pain
- Lower back pain
- Leg pain
- Arm pain
The therapy is also being researched for possibly treating multiple sclerosis and paraplegia.
What is a spinal cord stimulator implant?
Spinal cord stimulation for chronic pain works by sending small electrical impulses via thin, flexible lead wires to the site of pain. Rather than the perception of pain, you will perceive a slight tingling or buzzing sensation known as “paresthesia.” Many patients report that parathesia is a pleasant feeling, and is certainly far more desirable than the pain they had previously felt.
Debuted in the 1960s and known then as dorsal column stimulation (DCS), spinal cord stimulation technology was researched in a patient group of 500 for a period of five years. The original implants didn’t show much success, due to technology issues, inexpert implanters, and poor patient selection, among other factors. The last implant of the DCS was performed in 1973.
By the 1980s, stimulator technology had improved and was more similar to the technology used today. Percutaneous leads were developed, dual multipolar lead systems were utilized, and in 1999, Dr. Giancarlo Barolat replaced the name dorsal column stimulation with spinal cord stimulation. You can find out more about how this technology is continuing to develop at the International Neuromodulation Society website.
The permanent spinal cord stimulation device consists of thin, flexible lead wires that are attached to a small battery pack. The battery pack is placed in a small, subcutaneous (under the skin) pocket, unnoticeable except for an extremely small scar. The battery pack is small in size – a bit bigger than a book of matches, but smaller than a deck of cards. The patient will also have a small hand-held remote to control how much stimulation they’re receiving.
Am I eligible for a spinal cord stimulator implant?
To be eligible for spinal cord stimulation for chronic pain, the patient must go through a standard process. You must first try conservative methods. Conservative methods may include but are not limited to:
- Medication management
- Hot and cold therapy
- Chiropractic treatment
- Minimally-invasive procedures, such as injections
A psychiatric and psychological assessment is also required by insurance companies and occurs to ensure the patient is mentally capable of using the device. Quality of the pain is assessed (is it continuous, sharp, burning, aching, etc.) by the pain doctor to discriminate whether the spinal cord stimulator would be helpful in the alleviation of the patient’s pain.
Once these measures have been exhausted, a patient may be considered eligible for spinal cord stimulation. Effectiveness for spinal cord stimulation varies from person to person, and so the procedure is broken down into two parts—a trial period followed by a more permanent solution if the trial effort is successful.
Trial periods for spinal cord stimulation involve a doctor making a small incision into your skin and inserting a temporary electrode inside. The entire outpatient procedure takes about one hour.
The electrical impulse generated by the electrode is controlled through a stimulator that the doctor will show you how to use. The stimulator is small, and you can carry it much like you carry a cell phone. During the weeks following the trial implantation, you’ll be able to test out the treatment and see if spinal cord stimulation for chronic pain works for you.
Patients that experience a reduction in pain by at least 50% are offered the more permanent treatment, according to the National Institutes of Health. If the trial is deemed successful by both the patient and the pain doctor, a permanent device may be considered.
Watch as one pain doctor implants a trial device in the video below.
When is it not advised?
As Spine-Health explains, spinal cord stimulation for chronic pain is not advised if you have:
- Infection at the site of the implanted device
- A demand-type cardiac pacemaker
- Severe depression or other psychiatric condition
- Untreated bleeding disorders
- Untreated drug addiction issues
How is a spinal cord stimulator implanted?
The second part of the implantation process is a permanent procedure. This is an outpatient procedure that is typically completed with a local anesthetic and sedative to ensure your comfort. The spinal cord stimulator generator is placed under the skin, along with coated wires that are linked to nerves or placed inside the spinal canal.
Although most patients are able to return home the same day as the procedure, others are kept at the hospital overnight. During the recovery period, you must care for the incision site and take it easy for a few days, refraining from lifting, stretching, bending, or twisting. Walking or other light exercise is recommended to speed the healing process and build strength.
After spinal cord stimulation surgery, life returns to normal. Most patients don’t notice the devices after their body heals.
Your doctor will help you determine the appropriate strength of the electrical current. By using the stimulator, you’ll have the ability to control the treatment frequency and duration. Typically, people use the stimulators for one to two hours, anywhere from three to four times each day.
Will spinal cord stimulation for chronic pain work for me?
Spinal cord stimulation shows the most promise for patients who suffer from nerve-related pain or damage.
Also, patient success for spinal cords stimulation is heavily influenced by how soon the therapy becomes available to them, research says. Although the success of treatment varies depending on the person and cause of chronic pain, research has shown that spinal cord stimulation is most effective when started quickly after the onset of pain.
Researchers at the American Academy of Pain Medicine found success rates as high as 75% for people who received an electrode implant less than two years after pain started. Meanwhile, patients who had been experiencing pain for 20 years saw a success rate of just 15%. Other research has found long-term success rates around 50%, according to the study. Dr. Krishna Kumar, of Saskatchewan, Canada’s Regina General Hospital notes:
“The success of SCS is time sensitive, in that as wait times decline, long-term outcomes with SCS are enhanced. Chronic pain is a disease unto itself, which is responsible for physical and psychosocial suffering. The importance of timely treatment must, therefore, be recognized by all physicians.”
The study reviewed outcomes for 443 patients, and it analyzed factors ranging from age and gender to the specialty of the referring doctor. The typical patient initially sought medical care about three months after developing pain. On average, family doctors worked to alleviate their patients’ pain for about one year. Patients then generally saw a specialist, who oversaw pain for an additional 40 months. All told, patients generally waited just over five years before being referred for spinal cord stimulation.
What does the research say?
Since this is procedure that has been performed for many years, there are multiple studies examining its usefulness for treating pain. Here’s just a few:
- Health Technology Assessment’s study that suggests spinal cord stimulation can reduce pain associated with complex regional pain syndrome and failed back surgery syndrome
- The ANNALS Academy of Medicine Singapore study that discusses indications for spinal cord stimulation use in patients, especially in relation to CRPS, failed back surgery syndrome, ischaemic and phantom limb pain, coronary artery disease
- A study from Surgical Neurology on the efficacy of spinal cord stimulation for peripheral neuropathy pain
What are common spinal cord stimulator problems?
As noted, the most common reason spinal cord stimulation might not work is the amount of time you’ve been in pain. Every year that passes could diminish the promise of successful treatment outcomes. However, the type of specialist you see can influence the amount of time it takes to receive treatment. Researchers said neurosurgeons made referrals the fastest, while non-implanting anesthetists were, on average, the slowest to refer patients. The time difference between the fastest and slowest specialists was more than two years.
Also, even though spinal cord stimulation is referred to as “permanent,” patients have options for stopping the therapy if they wish. The implanted devices can be removed or turned off. Additionally, keep in mind that the implanted equipment runs on batteries, some of which are rechargeable. Non-rechargeable devices last up to five years.
If the generator you receive doesn’t have a rechargeable battery, you’ll need to undergo additional surgery to receive a new battery once the initial one wears out. However, even the rechargeable pieces of equipment sometimes wear out and need replacing. If it’s damaged, it may also need to be replaced, leading to another procedure.
Are there any spinal cord stimulator complications?
As with any procedure, there are risks of complications. The most serious of these include damaging the nerves that come out of the spine. This could lead to paralysis, weakness, or pain that does not go away. Talk to your doctor to ensure they’re using the most up-to-date imaging techniques, such as fluoroscopy to reduce this risk.
Other complications relate to the device itself. A stimulator that sends too strong or low of a signal, doesn’t work correctly, or doesn’t work at all, will need to be examined and possibly replaced by your pain doctor.
Finally, as MedLine reports: “The SCS device may interfere with other devices, such as pacemakers and defibrillators. After the SCS is implanted, you may not be able to get an MRI anymore.”
What are spinal cord stimulator side effects?
Side effects of spinal cord stimulation for chronic pain are minimal. Those that do exist consist of:
- Minor pain at the surgical site
- Scar tissue developing around the electrode
- Infections at the injection site, which necessitates removal of the hardware
- Damage to the generator or leads that requires additional interventions
- Lead migration
Spinal cord stimulation for chronic pain is best used in conjunction with other therapies, such as physical therapy. As Back.com explains:
“Realistic expectations are key to being satisfied with any pain treatment. It is important to remember that neurostimulation will not eliminate the source of your pain or cure any underlying disease, but can help you manage the pain.”
To be considered for spinal cord stimulation, you must meet certain medical criteria. To start, the pain must not be linked to cancer. Next, patients generally must have tried other, more conservative treatment options for at least six months with little result. Patients receiving spinal cord stimulation must not have a pacemaker or a major psychiatric disorder.
However, for the right patient, spinal cord stimulation for chronic pain could provide immense relief. Up to 75% of eligible patients did find relief with this treatment. Your pain doctor can help you learn if you’re a good candidate for this procedure. If you’re ready to talk to a pain doctor in your area who specializes in spinal cord stimulation for chronic pain, click the button below.