Spinal Cord Stimulation Therapy for Chronic Pain

Spinal cord stimulation (SCS) is an advanced therapy for long-standing pain in the back, arms, legs, and multiple other areas. SCS is part of the growing field of neuromodulation, the study of technology and electricity to decrease pain. Neuromodulation is well studied and approved by the Food and Drug Administration (FDA) in the United States.

SCS was introduced for medical use 40 years ago. Since then, SCS has continued to evolve and progress every year, with technology and careful research leading to better treatment options and outcomes for patients. In the last two years alone, there have been remarkable developments in the way that the electricity is transmitted to the spinal cord to reduce pain.

This treatment works by blocking pain signals from traveling up through the spinal cord to the brain. It involves placing a small device near the spinal cord. The device delivers low-level electrical pulses that stop you from experiencing pain, especially chronic nerve pain. Many are familiar with the concept of a pacemaker, where a battery and wires are placed to treat heart conditions. SCS is like a pacemaker for treating pain.

Pain conditions treated with SCS

The syndromes most commonly treated with SCS include:

• Nerve Root Pain: Bones or discs in your spine press on a nerve, resulting in neck, back, arm, or leg pain.
• Failed Back Surgery Syndrome: Pain that continues or even increases after a surgery meant to relieve your back pain.
• Sciatica: Pressure on the sciatic nerve causes low back, leg, or buttock pain. SCS is especially an option for sciatica that surgeons feel would not be helped by surgery.
• Complex Regional Pain Syndrome: Severe arm or leg pain that starts after an injury, a surgery, or even without a known cause. It is often accompanied by skin color and temperature changes.
• Neuropathy: Pain in your hands and feet that feels like a burning sensation.
• Central Sensitization: Pain that starts to be amplified in the brain and spinal cord. This condition can be associated with an injury to the spinal cord or brain.

To read more about pain conditions that improve with SCS, click here.

How SCS works

A small device, known as a generator (or battery), is placed under the skin in the back. The generator is attached to thin wires that go to the epidural space, the space next to the spinal cord. The wires have electrical leads at their tips that send mild electrical pulses to the spinal cord in order to block pain signals.

With regards to what you will feel, the SCS system can vary depending on your preference. Some patients may choose to feel a pleasant tingling sensation in the area of pain while others prefer not to feel the tingling and just have the pain blocked. Patients may prefer a combination of options and have several programs of electrical stimulation that vary depending on the type of pain, time of day, or severity of pain. The electrical pulses disrupt the brain’s ability to process pain signals and “distract” you from feeling pain. The key is that the stimulation is tailored to suit your specific needs.

For pain in the legs, back, abdomen, and pelvis the electrical leads are placed in the mid-back or thoracic area. For neck, arm, and chest pain the leads are placed in the neck.

You control the strength of the electrical pulses, with a hand-held control. If needed, you can also turn off your stimulation therapy for certain amounts of time.

The procedure

Your pain specialist will evaluate the source of your pain based on your medical history, neurological exam, and imaging studies. Your pain specialist will determine if SCS may be an option for your condition.

1. Device Evaluation. During the trial, the pain specialist will place a temporary stimulator device. The device is attached to flexible metal wires (leads) that are placed in your back. Some people choose to work during this period of the trial and others take the week off from work. The ability to go to work during the trial may also depend on the level of strenuous activity associated with your job. The device remains in place over a trial period of several days or a week. During this time, you learn how to use your hand-held control in order to adjust the strength and quality of the electrical pulses. Your direct experience with the device helps you to know if the device is likely to help you in the long run. Even though the device is placed in your back, the electricity can treat pain in areas other than your back – legs, abdomen, groin, pelvic area, etc.
2. Permanent Implant. Only you can determine if the trial was a success. Success during the trial means that you have significant pain relief in your painful area, improved sleep, an increased ability to move and live comfortably during the week. If the trial is a success, you will report your experience to your pain specialist. The pain specialist will either perform the permanent implant or refer you to another physician who performs it. The placement of the SCS is a minor surgical procedure. It is performed in a hospital or surgery center. You may go home the same day or stay overnight.

Uses of SCS

Spinal cord stimulation is a well-established and well-studied therapy for the treatment of long-lasting pain. Pain specialists use it to treat various pain syndromes.

SCS is:

1. Often used for treating chronic nerve pain (pain marked by burning, tingling or numbness).
2. An option for pain that does not improve with surgery, pain medications, nerve blocks or physical therapy.
3. Effective for low back pain in patients with many different conditions (failed back surgery syndrome).

Benefits of SCS

A trial period allows you to first try the device for about one week. You will be able to feel the effects of the electricity and determine if a permanent implant is right for you.

Some benefits of SCS are:

• A permanent implant is a minor surgical procedure with a rapid recovery.
• Recently, there has been the development of MRI compatible SCS options, so you can have an MRI even with the device implanted. This is especially important for a patient who requires frequent monitoring by MRIs, for example, to assess tumor size or for patients who have multiple sclerosis.
• By using electricity, there are NONE of the side effects that can accompany medications, such as weight gain, sedation, or constipation.
• Pain can change given the time of day or the circumstance. Once, implanted, you control your stimulation with a handheld remote. You will be able to make adjustments to the settings to achieve the pain relief you need.
• The device is totally inside your body when it is permanently implanted. No one will know you have the device unless you tell them. You will be able to swim and enjoy any other activity that you normally do.
• Unlike a surgery, SCS is reversible, meaning that the device is removable if it is no longer necessary.

Risks

For the spinal cord stimulator implant procedure, the risks are low. However, it is important to be aware of them:

• Infection
• Bleeding
• Inadequate coverage of the painful area
• Nerve problems

Outcomes

Spinal cord stimulation is an effective therapy for reducing chronic pain. However, it does not work for everyone. A benefit of this therapy is that a trial is offered with a temporary device. If you have significant pain relief during the trial, your doctor will place a permanent stimulation device. However, if your pain does not improve, you will not proceed to an implant.

There is strong scientific evidence that SCS is likely to offer short-term pain relief after failed back surgery syndrome and complex regional pain syndrome. There is moderate evidence that SCS can offer long-term relief for these conditions.

A recent study concluded that approximately 50 to 60% of patients with failed back surgery syndrome had greater than 50% pain relief with SCS therapy. People suffering from spinal stenosis who received SCS had a 67% improvement in pain, based on their pain scores, a decrease in pain medication, and ability to function.