For patients with chronic back, leg, or arm pain who have not found relief from other treatments, spinal cord stimulation (SCS) is an additional option to consider. Spinal cord stimulation, also called neurostimulation, is a non-medicinal approach that masks pain signals before they reach the brain.
A small device called a spinal cord stimulator, similar to a pacemaker, is implanted in the body. This device delivers mild electrical stimulation to nerves along the spinal column, modifying or blocking nerve activity to minimize the sensation of pain reaching the brain. Traditionally, the perception of pain is replaced with light tingling, called paresthesia. The goal is a 50 to 70 percent reduction in pain.
One of the obvious upsides to this treatment is that it can enable you to participate in daily activities with less pain. This approach deals with pain in a way that reduces or even eliminates the need for opioid painkillers or other pain medications.
Who Is a Good Candidate?
The ideal patient for a spinal cord stimulator is one who has not responded to more convervative therapies and who has one of the following conditions:
- Complex Regional Pain Syndrome (CRPS) or Reflex Sympathetic Dystrophy (RSD)
- Nerve damage
- Spinal cord damage
- Phantom limb pain (PLP)
- Back pain, especially in those cases when it continues even after surgery (Failed Back Syndrome – FBS)
Any patient who is considered a good candidate for spinal cord stimulation therapy must go through a thorough screening process before undergoing the procedure.
Spinal cord stimulation does not work for everyone. Some find the neurostimulation sensation to be uncomfortable, and for others, the treatment doesn’t fully address their areas of pain. As a result, before a spinal cord stimulator is permanently implanted, a trial stimulation is always performed first. If the trial does not live up to expectations, the trial wires can be removed in a simple office procedure with almost no discomfort and without damaging the spinal cord and nerves.
With the trial procedure, a patient receives an external test stimulator in a simple outpatient procedure where temporary leads are placed via a needle using flouroscopy for guidance. During a three- to ten-day trial period, patients receive stimulation through these thin, temporary lead wires which are connected to an external trialing cable and an external test stimulator. A trial is considered successful when it results in pain relief of at least 50% accompanied by an improvement in function.
The trial leads are always removed at the trial’s conclusion. If the trial procedure has been successful, a permanent implantation is scheduled to be performed at a later date.
Permanent implantation is done as a minimally invasive outpatient procedure. During this procedure, the generator is placed underneath the skin and flouroscopy is used to determine where the electrodes are placed. Long term success with this procedure is often determined by how skilled a surgeon is when placing and anchoring the electrodes to minimize movement over time as the patient actively goes about their life post-procedure.
After the implantation, the healthcare team monitors the healing process and adjusts the settings on the stimulation device to optimize the therapy and pain control. After slight adjustments in the first few weeks, the settings on the spinal cord stimulator are often stable.