Spinal Cord Stimulation

Posted by steeldove @steeldove, Oct 25, 2018

Spinal Cord Stimulation – A Compelling Treatment Alternative for Chronic Pain
Vladimir N. Kramskiy, MD
Assistant Attending Neurologist, Hospital for Special Surgery
Clinical Assistant Professor of Anesthesiology, Weill Cornell Medical College

What Is Spinal Cord Stimulation?

Spinal cord stimulation is a neuromodulation technique that is used to treat various types of chronic pain. Neuromodulation is a pain management therapy that uses electrical signals delivered by an implanted device to alter nerve activity in specific parts of the body in order to reduce pain. Similar to the way a pacemaker corrects an abnormal heartbeat, a neuromodulation device can establish neurological balance that may help reduce symptoms associated with pain.

The field of neuromodulation has developed rapidly since the first implantable spinal cord stimulator device was used to treat pain in 1967. A specialized pain management doctor can implant the transmitter device through a minimally invasive surgery. Physicians who have specific training in neuromodulation techniques have reduced complications and adverse events associated with this procedure. For this reason, it is vital that patients carefully choose a board certified pain specialist with expertise in neuromodulation before committing to any therapy.

Newer spinal cord stimulation devices and technologies have resulted in improved outcomes. The treatment involves placing electrodes next to a specific spinal area presumed to be the source of pain. These, in turn, provide an electric current which achieves the neuromodulatory effects that relieve pain.

Any patient who is considered a good candidate for spinal cord stimulation therapy must go through a thorough screening process before undergoing the procedure. This includes:

In-depth history and physical examination to assess for medical conditions that increase the risk that the treatment will either fail or create complications
Routine laboratory evaluation (determined based on the patient’s medical history and the type of anesthesia that will be used during the implantation procedure)
Relevant spine imaging studies (for example, X-ray films, CT and MRI scans) to assess the potential for technical difficulties that could arise during the procedure and to identify those patients for whom surgery may be a more appropriate treatment
Psychological screening (often required by insurance companies for approval of payment)
For patients with cardiac issues, a consultation with a cardiologist as well as a compatibility test
Despite this careful selection process, some patients will not achieve optimal pain relief with spinal cord stimulation. Most often, this is due to factors such as lifestyle (for example, preexisting tobacco or drug use), age or a lengthy delay between the first appearance of pain symptoms and device implantation.

What Patients Need to Know About the Spinal Cord Stimulation Process

First, a patient who is a good candidate for neuromodulation therapy is given a trial of the treatment. This trial tests the effectiveness of pain control and the patient’s tolerability to the device before it is permanently implanted.

During the trial period, which typically lasts three to seven days, temporary leads are placed via needle and connected by an extension cable to an external generator. A trial is considered successful when it results in pain relief of at least 50% accompanied by an improvement in function.

After the trial period, the leads are removed and the permanent implantation is performed at a later date (typically, two to four weeks later, to make sure there is no evidence of infection). A small incision is made during the implantation surgery. About a week after the implantation, a patient will return the office so that the healthcare team can monitor the healing process and review the settings of the device. Initially, most spinal cord stimulators need slight adjustments in the first few weeks after implantation, but the settings are often stable thereafter.

Spinal cord stimulation is a compelling treatment alternative for patients with chronic pain who have failed conservative treatment approaches. While it may not be effective for all types of pain or for every patient, spinal cord stimulation is a safe, drug-free and cost-effective treatment for many chronic pain conditions.

Posted: 10/8/2018

Tank you for the information regarding the Spinal Card Stimulation. My only question has to do with the numbness pain, tingling and pins and needles pain sensation in both legs, feet fro the waist on down. Does this stimulation help with those pains?
Thanks in advance for your reply.
Fred

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@goetf4997

Tank you for the information regarding the Spinal Card Stimulation. My only question has to do with the numbness pain, tingling and pins and needles pain sensation in both legs, feet fro the waist on down. Does this stimulation help with those pains?
Thanks in advance for your reply.
Fred

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@goetf4997 Sorry that I don't have an answer for you Fred, but I suggest that you contact Vladimir N. Kramskiy, MD
Assistant Attending Neurologist, Hospital for Special Surgery who authored the article. The Hospital for Special Surgery is in New York City, and interestingly, is the only hospital that outranks Mayo in Orthopedics.

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@goetf4997

Tank you for the information regarding the Spinal Card Stimulation. My only question has to do with the numbness pain, tingling and pins and needles pain sensation in both legs, feet fro the waist on down. Does this stimulation help with those pains?
Thanks in advance for your reply.
Fred

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Fred a great story was recently posted on Mayo Clinic Sharing about a patient that had success with a Spinal Cord Stimulator implant. This may help with your discussion with your provider of choice.

https://sharing.mayoclinic.org/2018/10/26/putting-pain-in-the-past/

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Thanks so much for posting this. My pain management doctor has recommended this and I’m trying to get as much information as possible about this before my next appointment. This was very helpful.

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I don't get on here as much as I'd like. Pain. Job. Life. But man, what a blessing this web-site, community is. Thanks for being here for us, Mayo!

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I’d like to echo what you said. This site is the BEST! The information is so helpful! It’s nice to know I am not alone and there’s a place I can go to to get some answers. My heart breaks for those who suffer so much more than I do. You are in my prayers! Finally, thanks to the moderators and volunteers for your helpful comments and advice!

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I had the trial for pain cord stimulator. My Mayo Dr
sent me to a closer Dr. at the time I thought it helped 50 percent, that was until the week was over.
I quickly realized it helped 70 percent and I can’t wait to get the implant. Honestly the buzzing affect
didn’t bother me as much as pain.
I ended up with help from lead manager, who called everyday, to set it just on my legs. My back hurts but not as bad as legs. I want to walk, I’m very weak I haven’t done much in 2 years.

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@goetf4997

Tank you for the information regarding the Spinal Card Stimulation. My only question has to do with the numbness pain, tingling and pins and needles pain sensation in both legs, feet fro the waist on down. Does this stimulation help with those pains?
Thanks in advance for your reply.
Fred

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They can set the remote to work on just legs or legs and back.

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@user_chf56161a

I had the trial for pain cord stimulator. My Mayo Dr
sent me to a closer Dr. at the time I thought it helped 50 percent, that was until the week was over.
I quickly realized it helped 70 percent and I can’t wait to get the implant. Honestly the buzzing affect
didn’t bother me as much as pain.
I ended up with help from lead manager, who called everyday, to set it just on my legs. My back hurts but not as bad as legs. I want to walk, I’m very weak I haven’t done much in 2 years.

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I’m glad to hear that your trial was successful! I hope the implant will go well too and you will get back to walking. That will make you feel so much better. My thoughts and prayers are with you!

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We considered this for my wife's chronic pain with the pudendal nerve. However, before any procedure like this I wanted to know about all the positives and negatives that I could get which unfortunately the manufacturers of these stimulators would not provide. Questions like what are the more serious side effects and frequency of these side affects? What affect does the the probes have on surrounding nerves that still have to perform their specific functions (all are being stimulated?) Has this device been tested on the particular nerve that you are dealing with?

The doctor that we spoke with at Mayo didn't have many positives to say about this procedure. My researched also uncovered some possible (don't know the percentages) serious side effects and as it turned out a neighbor around the corner from us developed as a result of having this procedure performed on him. So given that there were too many unknowns my wife opted out of having this procedure. However, do not take this as your only input to make a decision. Do your own research and most importantly try to get as many inputs from patients as you can as I find that source to be most valuable.

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Hi bkruppa, just to give you my input, I was incapacitated from 2010- 2012 following an inguinal mesh hernia repair, I had a spinal cord stimulator fitted in October 2012 in the Mater Private in Dublin, I went back to work after 2.5 years in February 2013.it really got me through a tough time and gradually improved to a point where I could again function normally , unfortunately through my own fault I re-injured the area again in November last which has grounded me again, I had my battery replaced about a month ago , which will give me more range and quiet stimulation, ie it works away in the back round .
so I am in recovery mode again, but I feel I wouldn't have had the relief I had if I hadn't taken the risk in the first place, I felt I had no choice at the time.
Regards, Sean

Liked by user_chf56161a

REPLY
@bkruppa

We considered this for my wife's chronic pain with the pudendal nerve. However, before any procedure like this I wanted to know about all the positives and negatives that I could get which unfortunately the manufacturers of these stimulators would not provide. Questions like what are the more serious side effects and frequency of these side affects? What affect does the the probes have on surrounding nerves that still have to perform their specific functions (all are being stimulated?) Has this device been tested on the particular nerve that you are dealing with?

The doctor that we spoke with at Mayo didn't have many positives to say about this procedure. My researched also uncovered some possible (don't know the percentages) serious side effects and as it turned out a neighbor around the corner from us developed as a result of having this procedure performed on him. So given that there were too many unknowns my wife opted out of having this procedure. However, do not take this as your only input to make a decision. Do your own research and most importantly try to get as many inputs from patients as you can as I find that source to be most valuable.

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My doctor recommended a spinal cord stimulator to relieve the nerve pain in my arm and hand. After two years of trying other things nothing else has worked. I have done a lot of research and have pretty much decided not to have the surgery for a trial. From what I read stimulators are fairly successful at reducing back and leg pain., but I couldn’t find anything which said they help with arm and hand pain. I also asked to speak with another of my doctor’s patients with arm or hand pain who was helped by a spinal cord stimulator. That never happened. Finally, two other doctors said that very few of their patients were helped by them. Based upon all of this plus my out of pocket cost, I decided it would be best not to do. I think it is the right decision.

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@seanivor

Hi bkruppa, just to give you my input, I was incapacitated from 2010- 2012 following an inguinal mesh hernia repair, I had a spinal cord stimulator fitted in October 2012 in the Mater Private in Dublin, I went back to work after 2.5 years in February 2013.it really got me through a tough time and gradually improved to a point where I could again function normally , unfortunately through my own fault I re-injured the area again in November last which has grounded me again, I had my battery replaced about a month ago , which will give me more range and quiet stimulation, ie it works away in the back round .
so I am in recovery mode again, but I feel I wouldn't have had the relief I had if I hadn't taken the risk in the first place, I felt I had no choice at the time.
Regards, Sean

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Sean………..and I've heard many similar stories where the stimulator has helped with their pain. However, there were too many questions that I could not get answers to that were of importance in making our decision on using this device. A doctor I spoke with also indicated some negatives so overall we decided not to pursue this option. What amazes me in your post is the reason for your nerve pain which was the hernia repair. What should have been a very simple operation resulted in you having a totally new and worse problem. That is troubling and I've heard this story many times.

REPLY
@goetf4997

Tank you for the information regarding the Spinal Card Stimulation. My only question has to do with the numbness pain, tingling and pins and needles pain sensation in both legs, feet fro the waist on down. Does this stimulation help with those pains?
Thanks in advance for your reply.
Fred

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Fred, I've just joined this group so that's why my comment is so long in the coming. I had the Spinal Cord Neuromodulator put in between my T8-T9 Spine for several reasons. My neuropathy in my legs and feet was intolerable, and I have a bulging L5 laying on my L1-L4, of which wasn't allowing me to walk much without serious pain and difficulty. Since I needed relief from the L5 down to my toes, they had to shave bone from between the T8-T9 in order to fit in the full paddle and not just wires. This was done in October '16 and I cannot begin to tell you how much relief I get from this implant. Basically, it gave me my life back, I was able to ween off of all my pain medications and even the Gabbapentin (nerve ending medications). I'm living once again and am about to return to work since 2002.

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