What Is Spinal Cord Stimulation?

If you suffer from chronic pain that hasn’t responded to other treatments, a spinal cord stimulator could help. Spinal cord stimulators are devices that deliver low-level electrical stimulation to block pain signals. They’re considered the “pacemakers for pain.” And, although the stimulator may not provide pain relief in all cases, previous literature has demonstrated that approximately one-half of all patients who use a trial spinal cord stimulator report significant pain relief. Over 70% of patients who used an implanted spinal cord stimulator for neuropathic pain reported pain relief benefits.

Spinal cord stimulation is reversible, safe, and effective. It can manage specific types of chronic pain that has not responded to other treatment modalities, such a medications, steroid injections, or physical therapy. Intractable pain, chiefly from neuropathic origins, responds favorably to spinal cord stimulation. Lesions on the central or peripheral nervous system can cause dysfunction and result in chronic neuropathic pain. Using spinal cord stimulation for the management of this type of chronic pain has been effective for many patients.

Spinal cord stimulation consists of inserting a medical device near the spinal cord that delivers low-level electrical impulses to the epidural space. These low levels of electrical impulse are the basis of signals sent through the body’s neurological system. Often these devices have a hand-held regulator you can use to send pain-blocking signals to the spinal cord as needed. Your goal is to override the pain signals the brain would be receiving from the peripheral nerves. The type of pain that originates from the spinal nerves is usually associated with damage caused by an inflammatory response or injury to the peripheral nerves. Stimulation at the spinal cord can correct these impulses and may effectively help to manage your pain levels.

The procedure is regarded as effective, reversible, and a safe treatment option for chronic pain as a result of neuropathic disturbances. Previously, studies have examined the effectiveness and found that over 70% of patients who used spinal cord stimulation after the trial period for their chronic neuropathic pain reported continued benefits from the device after a one-year follow-up. Scientists estimate that approximately 14,000 of these stimulation devices are used every year for the treatment of chronic pain worldwide.

Spinal Cord Stimulation For Chronic Pain

Chronic pain is a condition experienced by more people in the United States than diabetes, heart disease, and cancer combined, according to the National Institutes of Health. Cited as the most common reason that people contact their healthcare provider, pain is the leading cause of disability and chronic pain is the leading cause of long-term disability. It’s why another option for pain management–spinal cord stimulators–are such an important treatment.

Estimates of the prevalence of chronic pain disorders in the United States have been as great as 30%. The Institute of Medicine estimates that nearly 116 million U.S. citizens suffer from one type of chronic pain condition. This is only slightly lower than the 19% of people in 15 European countries who reported suffering from pain for greater than six months.

This study performed in 2006, which surveyed individuals regarding their pain experiences, also found that:

  • Over half of those reporting chronic pain were incapable of working
  • 20% reported that they had lost their job as a consequence of their chronic pain condition
  • Half of those surveyed reported that their pain was not being managed
  • Only 2% were being cared for by a doctor who specialized in the management of pain and chronic pain

Chronic pain often lasts longer than 12 weeks and usually after the normal healing process for the injury has passed. Chronic pain can result from an injury, illness, diseased tissue, or there may be no identifiable cause. It can limit the ability of the individual to complete their activities of daily living and create an environment where consistent mood changes become normal. Chronic pain, though, isn’t normal and there are treatments that can help. A spinal cord stimulator is one of the more advanced and effective options for pain management.

Spinal Cord Stimulator History

The rise of gate control theory of pain began the research that resulted in neurostimulation treatments for chronic pain. In 1965 Melzack and Wall proposed that the dorsal horn of the spinal cord would act as a “gate” to sensation carried to the spinal cord through the peripheral nerves. The theory that this gate could be closed or interrupted with the delivery of other electrical impulses to the peripheral nervous system formed the basis of spinal cord stimulation.

This interruption in pain signals could effectively control the perception and sensation of pain. From there it was suggested that embedding a stimulation device into the dorsal column of the spinal cord would deliver these electrical impulses and disrupt the delivery of the signal to the brain that indicated pain. In 1971 the first spinal cord stimulator used in the epidural space was used successfully to treat intractable pain.

The effectiveness of neurostimulation is well documented, although the exact mechanism is not fully understood. It was initially developed on the basis of the gate control theory for pain. However, that theory remains a theory without a full explanation of the exact modality of action. A small number of research studies have attempted exploration of the theory without any conclusive findings. It is believed that there are several different factors working together that would explain the assistance of spinal cord stimulation in the treatment of intractable pain.

Much technological advancement has been made since the development of the stimulator in the early 1970s that improved the effectiveness of the procedure in relieving and reducing neuropathic pain. In the original procedure to place the spinal cord stimulators, electrodes were positioned in the subarachnoid space. This is the space between the arachnoid and pia mater membranes that protect the brain, also known as the meninges. Changes were made in the 1970s when new electrode placement made it feasible to be located in the epidural space, outside the protective membranes that surround the spinal cord. The changes reduced the risks with spinal cord stimulator implants, such as leakage of the cerebrospinal fluid, infection, or inflammation of the meninges.