If your physician suggests a procedure called spinal cord stimulation as a means of treating your pain, some commonly asked questions are listed and answered below.
What is spinal cord stimulation?
Spinal Cord Stimulation (SCS) is used for management of chronic pain and is commonly known as the pacemaker for pain. Using similar technology to a heart pacemaker, SCS works by modifying the pain signals traveling to the brain, replacing them with a slight tingling or buzzing sensation that many patients say is pleasant or unnoticeable. Patients that may qualify for SCS have often unsuccessfully tried other forms of pain management, such as:
What type of pain is SCS ideal for?
Most chronic pain that is neuropathic (involving nerve damage). SCS is ideal for pain from the following:
Back and leg pain for patients that either do not desire or are at high risk for surgical intervention
Pain remaining from prior spine surgery
Phantom Limb Pain
Reflex Sympathetic Dystrophy
Residual pain from shingles
Some vascular diseases of the legs
Am I a candidate for the procedure?
Patients selected for this procedure have usually had a disability for more than 12 months, and have pain in the lower back and leg. Patients must have failed more conservative measures of pain control. Medical and psychological screening is used to determine which patients are appropriate for spinal cord stimulation trials.
What are the expectations for the procedure?
When SCS is recommended, a trial placement of the device is first performed — the leads will be inserted through a needle under x-ray guidance into the spinal canal. The patient is then able to take a “test drive” of the device, which will let them determine if SCS can help their pain.
If the trial is successful, a second procedure (permanent placement) will then be performed. This is when either the needle placement of the leads is repeated, or a “mini-laminectomy” to insert a different lead (paddle stimulator) is implanted. In either procedure, the leads are tunneled beneath the skin to a generator (battery).
How is the procedure done?
In spinal cord stimulation, an electrode is implanted through the skin into the epidural space of the spinal canal under x-ray guidance. Electrical stimulation of the spinal cord causes the pain sensation to be blocked and replaced by a benign vibratory sensation.
Spinal stimulation uses small electrical leads (say – “LEEDS”) that block pain signals from being perceived by the patient. The leads are selectively placed across the area of the spinal cord where the pain is generated. An appropriate program is used to interfere with the pain signal. This therapy offers relief to patients suffering with significant chronic back and extremity pain that has not responded well to traditional treatment options. If a trial of this modality proves to be effective, an internalized system can be surgically implanted. This can allow for long-term pain relief.
On the day of the procedure, the patient will arrive at the outpatient facility at least one hour prior to their scheduled surgery time. The patient should not have anything to eat or drink at least 6 hours prior to their surgery.
The procedure is usually done under mild sedation. A small intravenous (IV) catheter is placed in the arm through which the patient is given sedating medication. This will make the patient somewhat drowsy and less vulnerable to painful sensations, however, the patient will remain awake for the procedure.
Once in the operating room, the patient will be asked to lie on their stomach. The patient’s back is prepared with an antiseptic solution and surgical drapes will be applied. The skin will be anesthetized, or numbed, with a local anesthetic using a very thing needle.
A special x-ray device (fluoroscopy) will then be used to assist the placement of another needle into the epidural space. The epidural space is an area that is around (epi) the covering over the spinal fluid and spinal nerves (dura). This space typically contains just fat and blood vessels.
Once the needle is located in the epidural space, a thin wire electrode or “lead” containing anywhere from 2 to 8 electrode contacts will be placed under fluoroscopy vision into the epidural space near the area of the spinal cord where the patient’s pain can then, hopefully, be blocked. With the “lead” or electrode in place, a small electric current will be placed through it and the patient will be asked to relate where he or she feels the stimulation. It is typically felt as a gentle buzzing or tingling. In some cases, a second lead is used to allow coverage of more areas of the back or of the middle back region.
During a trial, attempts are made to “overlap” this feeling of stimulation to the area(s) that the patient typically feels their pain. When and if this can be done, the needle is removed and the “lead” (electrode) is then taped to the skin of the patient’s back. The patient is then instructed in the use of the trial generator.
The patient is then discharged and over the next 7 – 10 days, attempts to live as “normally” as possible. However, we do request that patients restrict themselves from bending and twisting so as not to displace the stimulator electrode wires. After one week, the patient is seen and the temporary stimulator is removed. (This typically is not at all painful and the removal of the tape holding the electrode on the skin is usually the most uncomfortable thing felt with the electrode removal.)
If the trial of spinal cord stimulation is successful, then the next step is to consider permanent spinal cord stimulation placement.
How long will pain relief last?
For most people, the pain relief is permanent. Patients may require periodic consultations with their pain doctor and the device representative for reprogramming. Continually fine-tuning the device to meet the specific needs of the patient improves the long-term success of this technology.
If you are interested in the spinal cord stimulator or would like more information contact the Deaconess Comprehensive Pain Center at 812-450-PAIN.
What are the risks and/or side effects of this procedure?
The risks to having spinal cord stimulation can include: nerve injury, contusions, neuritis, infection, paralysis, seroma and a lumbar puncture headache.