Pain Management with Spinal Cord Stimulation therapy – is it for you?
Pain management is an ever-evolving practice that continues to improve upon the efficacy of treatments and manage chronic pain more effectively. Spinal Cord Stimulation Therapy is an innovative, minimally invasive procedure to treat pain that can have life changing positive effects on patients without the same side effects as some traditional methods, including medications.
The brain and the spinal cord form a harmonious pairing called the central nervous system. The brain controls the body with electrical signals, the spinal cord functions as the main channel of communication from the body to the brain and from the brain back to the body.
Spinal Cord Stimulation Therapy is incredibly effective for a broad segment of chronic pain patients. If you feel a Spinal Cord Stimulator could improve your life, please schedule a consultation.
Pain management specialists are utilizing this innovative treatment technique to improve quality of life and improve efficiency for patients experiencing chronic pain – This article is an overview of Spinal Cord Stimulation (SCS) Therapy Schedule a consult with our team to determine if this procedure is right for you.
What is a Spinal Cord Stimulator?
A spinal cord stimulator is a device that is implanted into the body under the skin utilizing a minimally invasive outpatient procedure, electrodes are placed within the epidural space. Turning the device on, sends electrical stimulation to help with the patient’s pain.
The system is generally composed of two parts: the electrodes and a generator (similar to a pacemaker, that serves as a battery and helps to control the stimulation). This pairing allows a substantially similar lifestyle for patients, with a large improvement in quality of life for those that can use the device.
Because the spine houses so many of the pathways connected to the nervous system this procedure can substantially mitigate pain in many different areas of the body. Spinal cord stimulation technologies allow patients to receive (pain relief treatment) treatment while generally reducing complications and limiting the need for numerous surgical procedures.
Generally, the electrodes which receive and distribute electrical pulses are inserted into the epidural space (the area between the spinal cord and the vertebrae) and the generator is placed in the lower back area or in the abdomen just under the skin. An external remote control allows patients to control the level of stimulation from the device.
New Technology continues to improve the efficacy and benefits of pain management with spinal cord stimulation therapy
While Spinal Cord Stimulation Therapy was once a novel treatment, it’s proven to be an effective treatment over years of use in patients of all types. The ability to control the level of stimulation, and advanced programming along with less-invasive surgical procedures to implant devices has made this treatment an option for patients with many different pain management needs, helping to remove the need for medications and other traditional treatments for pain.
Highly specialized physicians that are focused on pain management and the spine generally place the devices using ultrasound and X-ray technologies using simple procedures.
Trial placement of a Spinal Cord Stimulator
As a patient, the process of determining whether you are a candidate for treatment using a spinal cord stimulator starts with a comprehensive understanding of past treatment history, your current pain management treatments and ultimately a trial implementation phase. During this process, an advanced imaging technique called Fluoroscopy is used to take a real time picture of your body as it moves, allowing doctors to place electrodes into the epidural space to ensure they are minimizing risk.
Where the electrodes are placed along the length of the spine will be determined by the specific location and type of pain you are experiencing. This process is almost always a quick, outpatient type of procedure.
A temporary generator and battery pack is then paired with the electrode, but not placed under the skin. This is to test how well the process works for you as an individual. A trial of a week or less may be used to determine how well you respond to the treatment and how successful we are at reducing your pain.
Permanent placement of a Spinal Cord Stimulator
If the trial is successful, you would then be scheduled for the implantation which will place a generator subcutaneously for a permanent solution. This process is also generally an outpatient procedure, but takes a bit longer (up to two hours including programming).
In the implantation phase, new sterile electrodes will be anchored with sutures to ensure minimal movement, and the generator will be placed for maximum effect and comfort. A couple of incisions will be made in this permanent procedure – they can be a few inches long. The same fluoroscopy technology is utilized to ensure risk of damage to the spinal cord is minimized.
IV sedation will be used during the procedure to improve patient comfort and minimize movement. The incisions will need to be sutured as well.
The following material is given as general information only and is not considered as medical advice or consultation.
Pain management with Spinal Cord Stimulation Therapy – Pain Management that does not solely rely on pain medicine
Patients and health care providers have recognized the benefits of minimizing drugs in the treatment of long term pain. Pain management specialists have sought out innovations like spinal cord stimulation for the largest possible improvement in quality of life. This treatment has been proven to be an effective treatment and can minimize ongoing concerns related to older, less efficacious treatments that may introduce risks to the patient over the long-term.
Non-narcotic treatments are incredibly effective treatment options and may mitigate many of the negative side effects associated with opioid based medications. They should form a basis for chronic pain management regimens.
Minimally invasive Spinal Cord Stimulation Therapy has the potential to lower the risk to the patient, significantly reduce long term side effects of other treatment options, and substantially improve patients’ quality of life.
Basic risks and understanding how the permanent placement of a Spinal Cord Stimulator could interact with the body
Infection from the incisions is a potential concern, but can be managed as part of infection control patient care.
Dural puncture is possible. The internal space of the spine is a sensitive and confined area. Any time there are procedures involving the spinal cord, the risk of dural puncture or paralysis, or nerve damage, while extremely rare, is present. This procedure is a proven and simple procedure, but it is focused on the spinal cord area, and therefore there are some risks that will be present during the procedure, and because of the introduction of physical implementations in that space.
Many years of use by a large patient population has shown that risks in using SCS are minimal and can generally be managed easily by scheduled appointments with your provider and self care.
Who is a candidate for a Spinal Cord Stimulation implant?
As a general rule, an ideal candidate for a Spinal Cord Stimulator will be a patient that requires better pain relief that cannot be achieved through less invasive therapies, or prior treatments. Because of the many negative effects of medication, Spinal cord stimulation and other non-narcotic treatments for chronic pain are considered primary treatments for the best quality of life and avoidance of side effects. Additionally, patients must not have certain psychiatric concerns that may counteract some of the efficacy of the spinal cord stimulation therapy.
Who can benefit from the pain mitigating treatment rendered by spinal cord stimulation therapy?
The following conditions can be treated effectively with Spinal Cord Stimulation Therapy
- Complex Regional Pain Syndrome
- Chronic back pain
- Post surgical pain
- Spinal cord injuries
- Pain as a result of amputation
- Some heart related diagnoses, including angina, among others
- Nerve specific pain
- Diabetic Neuropathy
- Peripheral Vascular Disease
- Other pain in various regions of the body
- Failed back surgery pain/Post Laminectomy Syndrome
What Can You Expect while being Treated with Spinal Cord Stimulation?
The pain management aspects of spinal cord stimulation therapy generally includes the use of electric impulses and electrical waveforms being used to improve how the brain responds to pain, and how the nerves contained within the spine react to pain. This may mean that multiple treatment programming options may be used by the system to handle different aspects of your pain management.
While most of the technology that is currently implanted into the body as part of SCS therapy, will be barely perceptible to the user, a slight recognition of this electrical impulse could be felt by the patient. The pain management specialist can adjust the program to compensate for these felt impulses. If you are experiencing any adverse effects it is important to consult your doctor immediately.
Living with a Spinal Cord Stimulator
While some diagnostic tests are generally safe, X-Rays, CT scans, and other diagnostics should not be taken unless your treating physician using the imaging devices is aware of your SCS device. This is particularly true of imaging devices like MRI’s.
The same is true for security screenings. Generally, the implant will be recognized by event or airport security.
While driving, a patient with an SCS related implant should not have any treatment active. Electrical impulses can cause involuntary movement in some rare cases.
Ultimately, if some complication arises – though it should be noted that complications with SCS technologies are exceptionally rare – a spinal cord stimulation device can be removed, if needed by your pain management doctor.
Finding the right partner for Pain Management
Comprehensive Pain Management Specialists has comprehensive pain management providers with extensive experience treating spine pain (and many other types of pain, including neuropathic pain) and using spinal cord stimulators as a treatment for various parts of the body. Our board certified pain management specialists have performed this procedure for hundreds of patients and are trained in the latest minimally invasive techniques.
Spinal Cord Stimulation Therapies and the medical devices that make up that treatment can be a durable, long-lasting and comfortable way to treat chronic pain of many different types. We are experts in SCS technology and in the implementation and use of these treatments as part of the management of your chronic pain.
Ultimately, each patient will need to work with a pain management specialist to determine the proper treatment(s) to manage their pain, and no one procedure or treatment should be considered a panacea for pain. We utilize various treatments, including SCS to bring quality of life improvements to our patients, and we invite you to explore what we can offer you in managing your pain (learn how we can create a personalized treatment plan to manage your pain more effectively). To explore other treatment types or schedule a consult [click here].
Frequently Asked Questions about Spinal Cord Stimulation Therapy
Am I a candidate for Spinal Cord Stimulator?
Spinal Cord Stimulation is offered to patients with chronic and severe neuropathic pain (pain due to damaged nerves), who have not received adequate pain relief with other treatments, such as physical therapy, psychotherapy, medications, surgery and/or injections.
Does it “fix” whatever is causing my pain?
Spinal Cord Stimulation does not cause any anatomical changes. It can, however, decrease the pain.
How will I know if Spinal Cord Stimulation will help me?
It is very difficult to predict if the procedure will indeed help you or not. Therefore, the procedure is done in two stages. In the first stage temporary leads are placed against the spinal cord and an external battery (which is the size of a pocket radio) is used by the patient to generate and customize the electrical stimulation. The patient then goes home, where he/she is given the opportunity to truly see if spinal cord stimulation alleviates the pain when engaged in his/her normal, day-to-day activities. The trial period is about 3-5 days. If this trial is successful in relieving at least 50 to 70% of the pain, implanting a permanent device is recommended. A separate appointment is then made to implant the permanent leads against the spinal cord and a battery under the skin. In the meantime since the trial leads are only temporary ones, they have to be removed to prevent and infection from occurring.
How is it actually performed?
The patient lies on their stomach for the entire procedure and is monitored with EKG, blood pressure cuff and a blood oxygen monitoring device. The skin is cleansed with antiseptic solution and then the procedure is carried out. Then a local anesthetic, (lidocaine), is used to anesthetize the skin and deeper tissues. The leads are then placed through a needle under x-ray guidance. The trial procedure is performed as an outpatient procedure. The permanent stimulator placement is performed in the operating room, but most patients usually go home on the same day the implant is performed. Some may need to be kept overnight for observation.
Will the procedure hurt?
The procedure involves an initial injection of anesthetic (lidocaine) through skin and deeper tissues using a very small needle prior to beginning the procedure. So, there is some initial discomfort involved. Most of the patients also receive sedation and pain relieving medications through an IV to help them relax, which makes the procedure even easier to tolerate.
Will I be “put out” for this procedure?
The placement of the temporary leads is done under local anesthesia. A pre procedure sedative can be given if necessary. This is necessary to ensure proper placement of the leads. The amount of sedation and pain reliever given in the veins generally depends upon how well the patient is tolerating the procedure and how sleepy he/she may be feeling… For the generator placement, patients are given stronger intravenous sedation.
Where are the leads inserted? Where is the battery/generator placed?
For the pain involving lower back, legs and/or feet, the leads are inserted in the middle of the lower back. The battery/generator is the placed in either the left or right upper buttock. Generators can also be placed in the abdomen.
For the pain involving the neck, arms and/or hands, the leads are inserted in the middle of the upper back. The battery/generator is the placed again either the left or right upper buttock.
Who should not have this procedure?
If you are on a blood thinning medication (e.g. Coumadin, Plavix) or if you have an active infection going on, you should not have this procedure.
What should I expect after this procedure?
If the procedure is successful, you may feel that your pain is significantly less. You will experience a fairly constant sensation of stimulation. You may have soreness for a day or two due to the needle injections.
What should I do after the procedure?
The patient should have someone give him/her a ride home the day you have the temporary and permanent implant. We advise the patients to take it easy for a day or so after the procedure in order to heal from the procedure and to prevent the leads from moving out of place. Activities can then be performed as tolerated.
If you have any questions about what activities are “safe or not safe” to perform, ask you Pain Physician.
How long will the battery/generator last?
It depends on how often the patient uses it, and the intensity of stimulation required to relieve pain. The longer it is used and the stronger the intensity, the shorter the battery/generator life. This can be as short as 1 year or as long as 5 years. Fortunately, at this time batteries can be recharged. Rechargeable units will last longer depending on use. Most are approved by the FDA for 5 years or more. They would only need to be removed if they failed to recharge. After the battery/generator wears out it has to be replaced in the operating room in order for the device to continue to work. The leads, however, do not need to be replaced.
How long does it take to change the battery?
One hour or less. This is done as an outpatient procedure.
What are the risks and side effects?
Generally speaking, this procedure is safe. However, with any procedure there are risks, side effects, and possibility of complications. Please discuss your concerns with your physician.
What about MRI Scans?
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What about going through metal detectors at the airport?
You will be given an identification card that has to be presented to the Transport Security Agent prior to going through the metal detector.
What about driving?
You should never operate a motor vehicle with the stimulator device turned on, since it could impair your ability to control the foot pedals.
About Our Services
The Comprehensive Pain Management Specialists team is dedicated to the advancement and treatment of pain disorders. Our highly trained health care providers utilize state of the art technology, innovative treatments, and procedures to provide our patients with the highest quality of care available. We specialize in treating pain with targeted interventions such as injections and other minimally invasive procedures. We have made it our mission to alleviate pain, restore function, and improve your quality of life.