Spinal cord stimulation for chronic pain.

Many of our patients have benefited from having a spinal cord stimulator implant to decrease their chronic back, leg, or arm pain when surgery and other modalities haven’t provided relief. Spinal cord stimulation masks pain signals before they reach the brain. It is a drug free option for patients with the following conditions:

  • Chronic leg pain (sciatica) or arm pain due to spinal stenosis or nerve damage in the spine
  • Post-laminectomy patients who have had failure of surgery to alleviate leg or arm pain
  • Complex regional pain syndrome (reflex sympathetic dystrophy) where patients have constant burning pain in their foot or hand
  • Stump pain
  • Spinal cord injuries
  • Multiple sclerosis
  • Peripheral vascular disease
  • Arachnoiditis (inflammation of the membranes that surround the nerves of the spinal cord)

Patients are evaluated for a spinal cord stimulator by reviewing their previous treatments such as medications, X-rays, MRI scans, physical therapy, injections, and surgeries. Candidates for spinal cord stimulators have chronic debilitating pain for more than three months in the low back, leg, or arm and conservative therapies have failed or surgeries have failed. Insurance companies require a behavioral health consult before a SCS trial to make sure that you would have a successful trial.

A trial of stimulation is performed for three to four days to see if a patient likes it. The trial wires can be removed without damaging the spinal cord or nerves. If a patient likes the trial and has insurance approval, a spine surgeon will implant a small generator (similar to a pacemaker) under the skin to deliver mild electrical signals to the spinal cord through a wire. This will stimulate nerves in the area of pain. The pain decreases because the electrical pulses change the pain signal from reaching the brain. The sensation is described as mild tingling. The goal is to decrease pain by 50-70% so that you can perform your daily activities more easily and decrease the use of medications.

Spinal cord stimulator systems consist of three parts: pulse generator, wire with electrodes, and a remote. A pulse generator has programmable settings and has a battery to create the stimulation. Non-rechargeable batteries need to be replaced surgically every 2-5 years depending on how often it is used. Rechargeable batteries can last 8-10 years but you will need to charge it occasionally. Some of the devices can automatically turn off when you lie down. A wire with electrodes that send electrical signals to the spinal cord. A hand held remote that can turn on and off the device and has different settings for different impulses. Some of the new devices are MRI compatible which means if you need an MRI scan, you can have one.

Spinal cord stimulation doesn’t cure the condition that is causing pain but it helps patients to manage the pain. Many patients have excellent long-term relief and some can return to work or discontinue medications. This procedure is fully reversible which means that the wires and generator can be removed if you decide to discontinue it. Many of our pain patients have told us that having a spinal cord stimulator has been “life changing” for them because they have less pain.

About the authors.

Margaret Klatt, MD and Mariam M. El-Baghdadi, MD are pain management physicians at HFM Pain Clinic.