I see a number of patients each year who have been treated for chronic leg and back pain with a spinal cord stimulator. For most, it was the last option they had left, and for many it has been a real blessing.
I also see a number of patients each year who have been offered or are considering having a stimulator placed for their ongoing pain. And they usually have a few questions.
Here are a few things you need to know if you are considering a spinal cord stimulator as treatment for your pain:
A spinal cord stimulator (SCS) is a device that generates pulsed electrical signals that directly affect the spinal cord to reduce chronic pain sensations. Similar to deep-brain stimulation, which is now becoming widely used to treat serious motor disorders such as Parkinson disease, the neural stimulators override some signals in the spinal column that are the source of severe and otherwise poorly controlled pain in a variety of disorders.
Spinal cord stimulation, in its simplest form, involves the placement of stimulating electrodes or an electrode paddle into the epidural space, inside the spinal canal and on the surface of the spinal cord. This is accompanied by implantation of an electrical pulse generator and battery, usually placed in the lower flank or buttock region, and passage of conducting wires that connect the spinal electrodes to the generator and battery. The generator is then tuned and modulated by remote control once the patient is awake.
Why go through all that?
SCS has notable analgesic properties (it does relieve pain) and, has been proven most effective in treating disorders for which there in no surgical solution or in which additional surgery is out of the question. In my experience, I have seen gratifying results for patients needing management of continued pain from scarring associated with failed back surgery syndrome, from limb pain due to complex regional pain syndrome (RSD), and refractory pain due to ischemic claudication.
Successful outcomes are dependent on careful patient selection, which means your pain doctor has to consider each patient individually and apply very strict “selection criteria” before placement can be approved. For that reason, SCS is not something that your doctor can just put in and turn you loose with.
In my practice, I work with a great group of experienced pain management experts, who see and evaluate each patient, carry out a careful physical and psychological evaluation (that’s absolutely needed before the procedure can be approved, so don’t be alarmed), and carry out a stimulator trial. Those doctors will then determine whether they can convert the stimulator to a permanent unit directly, or whether they need a surgeon to provide the permanent placement. After placement, it’s your pain management doctor, working with the stimulator representative, who can fine tune the system to get you your best result.
Patients typically do best when the majority of their pain involves radicular pain – pain running down the leg or arm - due to nerve hypersensitivity or injury. Patients do best when there is little or no dependence on opioid medications, and when there is minimal psychological overlay (depression, anger, anxiety) associated with their pain. Patients may be screened over a short period with a test or trial lead to determine if the placement provides a proper paresthesia (sensation over the painful area) and to ensure that satisfactory pain relief is achieved.
To be most effective, SCS is provided as a program. No good can be expected from just “having it put in” to see what happens. And the doctor who puts it in needs to be able to manage it or work directly with the experts who performed the trial and can manage the device properly. That’s why I always work hand-in-hand with experienced pain management groups (Cleveland Pain Care) who identify the patients that are likely to do well, do the preoperative testing, and manage the system for best results.
Finally, SCS is not magic, and does not correct the underlying problem that is causing your pain. From time to time I do see a patient who has been offered SCS as the FIRST option in treating their back or radicular leg pain. This is almost never the right way to go, and in each of these cases I’ve discovered clear-cut and sometimes easily correctable causes for pain. That’s an uncommon situation and not something I see among the providers I routinely work with, but it’s something to be aware of.
So, if you find yourself thinking that SCS has been brought up too quickly – or dismissed too quickly – for your pain problem, never hesitate to seek a second opinion.
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For more information on Spinal Cord Stimulation, check out (https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/treating-pain-with-spinal-cord-stimulators ) or browse for other links on my website at spinesurgerycleveland.com.