By Foead Geula, M.D.
Living with chronic back pain can be a very difficult task. It reduces mobility and makes it difficult to sleep or participate in recreation. Things such as failed back surgery, diabetic neuropathy, lumbar disc herniation and lumbar radiculopathy are some conditions amenable to pain relief through spinal cord stimulation. Often, one of the most difficult things about back pain is the inability to find relief. For many people, a spinal cord stimulation can help. This device uses wires implanted in the spinal canal to create an electrical impulse which interferes with pain signals, and it can be a very effective method of pain reduction. Spinal cord stimulation serves to modulate the transmission of pain impulses sensed by the body. It does so by delivering small electrical pulses that “distract” the nervous system from unwanted painful impulses. By overriding the nervous system’s circuitry, spinal cord stimulation may decrease the pain experienced by patients.
Indications for Spinal Cord Stimulation
Spinal cord stimulation requires surgery, so it is only indicated when less invasive pain management techniques have failed. Patients who have not experienced relief from methods such as massage, back exercises, medications, and epidural injections may be candidates for the procedure depending on their underlying source of pain. Some other indications for spinal cord stimulation include lumbar disc herniation and lumbar radiculopathy. Patients with sympathetically-maintained pain or CRPS. Patients with diabetic neuropathy may also benefit from a spinal cord stimulator.
Before permanent implantation of a spinal cord stimulator, we will perform a test stimulation to determine whether treatment is likely to be beneficial. If the trial is successful, implantation will likely be recommended. Using a local anesthetic, a small incision is made near the center of the patient’s back and permanent leads inserted under live intermittent fluoroscopic guidance. The physician then gives some test stimulation to ensure that the leads are properly placed and threads a wire from the leads to the area where he will implant the pulse generator. Finally, he makes another small cut where he inserts the device, and he sews up both incisions.
Recovery time varies from person to person, but the majority of patients are able to go home the day of the surgery. After discharge, the person may need narcotic drugs for a few weeks to manage the pain, and driving is usually restricted. Additionally, activities such as bending, climbing, twisting and lifting are generally discouraged for the first few weeks after surgery. After that, the patient can gradually return to his or her usual level of activity.
Although a spinal cord stimulator does not cure back problems, it can often reduce the pain considerably. Additionally, the device has the advantage of being extremely flexible and portable, allowing patients to oversee their own pain care, to travel, and to resume normal activities.
Every surgery carries some risk, and spinal cord stimulation is no exception. Potential problems include seepage of spinal fluid into surrounding tissues, hardware damage, headaches, infection and bladder trouble. Some patients can become acclimated to the device, making it less effective, and others may experience an uncomfortable amount of stimulation. In very rare cases, serious problems such as paralysis may occur. Spinal cord stimulation may decrease pain medication requirements, helping to avoid the side effects typically associated with many of these medications. Before implanting a spinal cord stimulator, your pain management doctor will conduct a trial to ensure that the device provides coverage for each patient’s specific pain pattern.