Spinal Cord Stimulation
Sunday, May 10th, 2009
Many people with the following conditions have received tremendous pain relief from Spinal Cord Stimulation:
Failed Back and Neck Surgery
Cervical, Thoracic and Lumbar Radiculopathy
Reflex Sympathetic Dystrophy (RSD)
Complex Regional Pain Syndrome
Post-Herpetic Neuralgia
Other nerve-related pain syndromes
Spinal Cord Stimulation (SCS) is a safe and effective treatment method for various pain syndromes. In order for you to perceive pain, an electrical pain signal must travel from the origin of pain to your brain. The spinal cord stimulator delivers an array of electrical stimulation that blocks these pain signals. It replaces them with a pleasant tingling sensation referred to as a paresthesia.
When discussing SCS with patients, I use the analogy of dropping a hammer on your toe. There is an obvious source (the hammer) and location (your toe). The pain signal travels up nerves in the foot and leg to the spinal cord. It then travels up the spinal cord into the brain. At that point, you perceive the pain. One instinct is to rub your foot or ankle (not the toe). This rubbing creates an alternate signal that confuses your nervous system. This reduces the amount of pain signals transmitted to your brain. The SCS device delivers an electrical stimulus (a.k.a. the rubbing) directly over the area in the spinal cord where the pain signal is traveling. It prevents your brain from perceiving the full pain signal.
A SCS trial consists of placing one or two catheters into the epidural space utilizing X-Ray guidance. No incisions are needed for this. Each catheter contains between 4 and 8 electrical contacts. The catheters are connected to an external battery. The device is programmed to provide comfortable coverage of painful areas. The patient can turn the device on/off, up/down, and change programs during the trial with a remote control. If greater than 50% of pain relief is achieved with significant functional improvement, the trial is considered successful. If we are both in agreement that this device will provide a significant improvement in quality of life, permanent SCS implantation is then scheduled. I perform these on an outpatient basis under moderate sedation and local anesthesia (not general anesthesia). On average, a trial takes 20-30 minutes and a permanent implant takes 75-90 minutes.
As an example, I recently performed a SCS trial for a patient who had 4 previous lumbar spine surgeries with continued low back and leg pain. After conservative management was exhausted, a two-lead SCS trial was performed 2 weeks ago. During the trial, my patient reported 80% pain reduction. As she enjoys gardening, she spent the entire week doing yard work that she has not been able to perform for years. She stated that it was the first time in years that she woke up in the morning with no pain. Permanent implantation is scheduled.
It is very important to realize that not everyone will benefit from a SCS device. Success begins with proper patient selection.
Tags: Complex regional pain syndrome (RSD), Failed Back Surgery, Injection Therapy, Neuropathic Pain, Pain Management, pain relief, peripheral neuropathy pain, phantom limb pain, post herpetic neuralgia, reflex sympathetic dystrophy, spinal cord, Spinal Cord Injections, Spinal Cord Stimulation, Spinal Cord Stimulation, Spinal Cord Stimulator Techniques, Spinal Cord Stimulators, Spinal Cord Stimulators