Treatments
7. Spinal Cord Stimulation (SCS)
Objective: A 50-70% reduction in pain, less reliance on pain medication, and return to a more active lifestyle, via implantation of a device that blocks pain signals with low-voltage electrical stimulation. Symptoms: Long-term chronic leg or arm pain, and/or constant chronic burning pain, typically in the foot or hand. Indicated for: Patients who have not found relief from traditional methods for: 1. Chronic leg (sciatica) or arm pain (ongoing, persistent pain caused by degenerative conditions like arthritis, spinal stenosis, or nerve damage). 2. Failed back surgery syndrome (failure of one or more surgeries to control persistent leg pain (sciatica), but not technical failure of the original procedure). 3. Complex regional pain syndrome (CRPS - a progressive disease of the nervous system in which patients feel constant chronic burning pain, typically in the foot or the hand. Formerly called reflex sympathetic dystrophy, or RSD). 4. Arachnoidities (painful inflammation and scarring of the meninges (protective layers) of the spinal nerves). 5. Other conditions such as stump pain, angina, peripheral vascular disease, multiple sclerosis, or spinal cord injury. Typically, if you’re a good candidate for SCS, you’ve had one or more failed spinal surgeries, and would not benefit from additional surgery. Conservative therapies have failed you, and you’ve also been disabled for more than 12 months. Not Indicated for: Patients with a cardiac pacemaker, patients seriously dependent on pain medication or other drugs, and/or patients who have depression or other psychiatric conditions that contribute to their pain. People with certain medical conditions also should not undergo transplantation. If your pain is caused by a correctable condition, then this must be fixed first.
Required Evaluation: We’ll evaluate your current medical regime, physical condition, and pain history to determine if you are an appropriate candidate for treatment. We’ll also review previous treatments, including medication, physical therapy, injections, and surgeries. Because pain also has psychological effects, a psychologist may assess your condition to increase the probability of a successful outcome.
Treatment: We implant a small, battery-powered device called a pulse generator under the skin of your buttocks or abdomen. An extension wire connects the pulse generator to the lead, another smaller device implanted above the spinal cord. The lead contains 4-16 electrodes and delivers the electric current to the nerve fibers of the spinal cord. You control the system via a handheld remote. A low-voltage electrical pulse is sent to the spinal nerves, preventing pain signals from reaching the brain. The stimulation feels like a mild tingling in the areas where the pain is felt. Some patients find the tingling sensation caused by the device unpleasant. For this reason, we first do a trial stimulation. If unsuccessful, the implant can be removed and does not damage the spinal cord or nerves.
Level of Relief: Varies for each person. (This is because stimulation does not eliminate the source of pain, it simply interferes with the signal to the brain.) The goal is a 50-70% reduction in pain. However, even a small amount of pain reduction can help you more easily perform daily activities with less pain and reduce the amount of pain medication you must take.
Technologies: There are many types of stimulation systems. The most common is an internal pulse generator with a battery. As sketched out above, an SCS system consists of: 1. An implantable pulse generator with battery that creates electrical pulses. 2. A lead with a number of electrodes (4-16) that delivers electrical pulses to the spinal cord. 3. An extension wire that connects the pulse generator to the lead. 4. A hand-held remote control that turns the pulse generator on and off and adjusts the pulses.
The battery inside the pulse generator delivers low voltage and needs to be surgically replaced every 2-5 years for a standard battery. Rechargeable battery systems may last up to 10 years, depending on usage. We’ll select the best type of system for you during the trial stimulation.
The pulse generator is programmable by us and has three settings: 1. Frequency (rate), i.e. number of times stimulation is delivered per second. Too few results in no sensation, while too many results in a washboard or bumpy effect. 2. Pulse width, which determines the size of area the stimulation will cover. 3. Pulse amplitude, which determines the threshold of perception to pain.