Pain is a complex thing and it is the number one reason why people in the U.S. search for help via the healthcare system. According to the U.S. Department of Health and Human Services, chronic pain is the most common cause of long-term disability. It can also be a barrier to treatment, accounts for a large portion of healthcare costs, and is the biggest reason for work absenteeism. But what do you do when your chronic pain doesn’t respond to standard treatments such as medications, steroid injections, or physical therapy? One approach is called spinal cord stimulation (SCS).
What is spinal cord stimulation?
Spinal cord stimulation has been around for about four decades. A permanent spinal cord stimulator device is made up of small, thin wires that have electrical leads on the end. These are placed along the spinal column. The wires are capable of delivering electrical pulses to the epidural space via a power source called an internal pulse generator. This can help relieve pain in some patients.
This treatment approach focuses on treating neuropathic pain. This is pain that develops as a result of damage to the central or peripheral nervous system. This is a major reason why spinal cord stimulation is so useful for patients of failed back surgeries. It can help alleviate pain even when the underlying cause has yet to be identified.
How does spinal cord stimulation work?
Spinal cord stimulation can be very effective in reducing overall pain, especially that from failed back surgery. This is likely because the electric charges produced by this medical device mimic the body’s natural neurological system. This has the effect of interrupting some of the pain signals being created by the body before they can reach the brain.
The spinal cord device comes with an exterior remote that allows the patient to send pain-blocking signals to the spinal cord as desired. This gives the doctor and patient some degree of control of these signals. The machine can be adjusted as needed to provide different levels of relief and can be turned on and off as the patient would like.
Spinal cord stimulation effectiveness is heavily dependent on the person, so this treatment option always starts out with a brief trial period. The trial usually lasts between three and 15 days to see if a patient will actually find relief from the device. A reduction of pain by at least 50% from the baseline with no major complications is required to consider a trial successful.
The science behind spinal cord stimulation
There has been quite a bit of research done on the effectiveness of spinal cord stimulation in the last 40 years. Much of it has shown that these devices are safe. It also shows that they are very good at managing certain kinds of pain. While there are many benefits to this treatment, there are still some complications inherent to the procedure.
One study, conducted by Dr. Young Hoon Jeon, MD, showed that SCS greatly improves the quality of life, daily function, and overall satisfaction of patients that undergo this treatment. It also revealed that most complications in this procedure are related to hardware issues. However, these issues were generally minor if the operation was overseen by someone with the proper expertise.
In another study, by KJ Burchiel et al, all 219 patients underwent a trial period for a SCS device of which only 182 patients obtained a permanent version. Of those who responded after one year, all of the pain and quality of life measurements used were significantly higher during the treatment year. Furthermore, complications were shown only to affect 17% of those patients. Overall, the study showed that spinal cord stimulation is a great pain management tool. It also has significant value in treating chronic pain in the lower back and extremities with minimal complications.
Spinal cord stimulation for failed back pain patients
A literature review was conducted by Michael Frey et al to exam the evidence and to evaluate the effectiveness of spinal cord stimulation, specifically relating to failed back surgery syndrome. This was measured by first measuring the pain relief provided in these studies. Then they took into account secondary measures that included functional status, psychological status, reduction of opioid medications, and the patient’s ability to return to work after the procedure. Overall, it was found that the evidence showing the effectiveness of SCS in relieving chronic pain from failed back surgery syndrome was obtained from well-designed trials. Further, case-controlled analytics studies backed the efficacy of spine cord stimulation on a long-term basis.
What is it like to have a spinal cord stimulator?
The procedure itself takes anywhere between an hour and 90 minutes to complete. During that, the pain doctor will place the leads near the spinal column with a needle. If the treatment is deemed successful, a more permanent spinal cord stimulation device is surgically implanted.
With spinal cord stimulation, you will first use a trial device. It comes with a preset program for the temporary electrical generator that you wear on your waist like a cell phone. If spinal cord stimulation is successful, a tiny electrical generator is implanted in the abdomen or upper buttocks via a small incision. The incision for the generator is so small that it will not be visible on the body. It will not inhibit any other activities, such as swimming.
The generator only requires new batteries every two to five years depending on use.
Risks of spinal cord stimulation
This treatment option is considered safe and easily reversible. However, there are a few reported complications to be aware of, although serious complications are very rare.
As with all surgeries, there is a risk for infection. Implanting a spinal cord stimulator also carries with it the possibility of scar tissue to build up around the wires and generator.
Other issues that can occur include:
- Migration of the electrode
- Unpleasant stimulation of the chest and ribs
- Cerebral spinal fluid leak
- Numbness or paralysis
- Hardware failure
- Allergic reaction
- Pain at the incision site
Have you ever received spinal cord stimulation for failed back surgery?