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When Back Pain Relief Remains Elusive

Neurostimulation Options for Patients and Practitioners to Consider When Conservative Alternatives Have Been Exhausted

August 2021

Almost everyone gets acute back pain from time to time. Maybe you did too much yard work, sat in a long car ride or were a little too enthusiastic in a pickup softball game. The end result – you get a backache or get some back pain.

That acute back pain may linger for a few days or few weeks. The good news is that kind of pain almost always goes away. You generally find things that get you by for that short period of time. It might be over-the-counter pain relievers, home remedies such as heat or ice, or maybe see a physical therapist or chiropractor to help you get through it.

A woman with lower back pain clutches her left back with her hand.

Chronic Back Pain

When you have chronic back pain however, you normally will seek out medical professionals. Chronic back pain is pain that just doesn’t go away. You’ve tried all your home remedies and maybe you’ve seen your family doctor a few times. But the pain continues to linger and persist.

Fortunately, there is an extensive range of treatments available ranging from conservative to more aggressive. Starting at the low end of this spectrum are alternatives such as physical therapy, medications, and injection-based treatments, to name a few. And at the top end of the spectrum is spine surgery.

However, what many back pain sufferers and medical professionals often miss are a growing number of pain relief alternatives that sit in the space between conservative treatments and major surgery. And among those alternatives are three classes of neuromodulation therapies: spinal cord stimulation (SCS), dorsal root ganglion stimulation (DRG), and peripheral nerve stimulation (PNS).

These are options that merit consideration when you want to avoid back surgery, or when back surgery has failed to provide the pain relief you are seeking. They also may be appropriate when you doctors haven’t been able to identify the specific musculoskeletal cause of your pain. We’ll take a brief look at each of them here.

Spinal Cord Stimulation (SCS)

A spinal cord stimulator is a medical device that delivers a set of mild electrical currents to disrupt pain signals traveling between the spinal cord and the brain. It is like a pacemaker for chronic pain.

It involves implanting a neurostimulator under the skin along with thin wires called leads. Together they provide pain relief by modifying pain messages before they reach your brain.

Before any permanent stimulator is implanted, a trial procedure is always used to help determine the likelihood that this therapy will work for a patient. This takes place over a 3 to 10 day period where an external stimulator mimics the treatment that would be delivered by the permanent implant.

The level of pain relief stimulation can be adjusted. Depending on the specific spinal cord stimulator, that adjustment can be done by the patient themselves according to when they need it throughout the day, or automatically with some newer technologies.

Both the trial and permanent implantation procedures are usually done on an outpatient basis. This device has over a 50-year track record of use, and in skilled hands, the serious complication rates are very low.

Dorsal Root Ganglion (DRG) Stimulation

Dorsal root ganglion stimulation is another outpatient neurostimulation therapy, similar to traditional spinal cord stimulation. However, rather than placing the electrodes over the spinal cord as in spinal cord stimulation, leads are implanted on the dorsal root ganglion, a cluster of neurons that represent the sensory gate of the spinal cord.

As sensory feedback moves to your brain, it first must pass through the dorsal root ganglion before entering the spinal cord. Thus, when those dorsal root ganglion neurons are properly stimulated, they can modify pain messages before they move to the spinal cord and other areas of the central nervous system.

Also, like spinal cord stimulation, dorsal root ganglion stimulation involves an initial trial to ensure the therapy is likely to be effective. Then the system is implanted under the skin during an outpatient procedure.

Dorsal root ganglion stimulation has number of advantages in appropriate situations. First, it can be targeted in a much more refined way than spinal cord stimulation and uses only 10 percent of the energy that spinal cord stimulation uses, leading to far longer battery life.

In addition, the leads are less likely to shift in comparison with spinal cord stimulation (although some surgeons are far better than others in how they anchor spinal cord stimulation leads to minimize slippage). And finally, given anatomical realities, patients receive the same pain relief whether laying down, standing, sitting, or walking – where the level of stimulation varies for spinal cord stimulation patients as they shift their position.

Peripheral Nerve Stimulation (PNS)

Peripheral nerve simulators work much like spinal cord simulators, except that we send the mild electrical currents directly to nerves outside of the spinal cord. Peripheral nerves run from your spinal cord to the limbs or organs in your body. Thus, if you have joint pain, a peripheral nerve stimulator would be localized directly at the joint where pain is being experienced.

Recently, a new generation of peripheral nerve stimulation devices has been developed. These new devices allow external pulse generators to transmit impulses wirelessly to the implanted electrode, and their implantation is significantly less invasive. Some devices and therapies are designed so that there is no permanent implantation necessary.

Chronic Back Pain Relief Alternatives at Main Line Spine

Main Line Spine’s team includes some of the nation’s leading experts in spinal cord stimulation, dorsal root ganglion stimulation and peripheral nerve stimulation medical technologies. These treatments, when combined with our multifaceted and compassionate care, deliver a high level of pain relief for our patients.

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