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

@user_chf56161a

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

Jump to this post

Did you get the simulator? I'm post-op 2-1/2 years now and it's set for both back & legs. I still don't feel the horrible pain in my low back, legs & feet.

REPLY
@laylabug

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.

Jump to this post

Wow! Good for you. Approximately how old are you? I ask because I have not been able to get treatment in Atlanta. I'm 72. Just wonder if they limit the good interventions to younger people now. Lastly, where did you find these amazing doctors?

REPLY
@jager5210

Wow! Good for you. Approximately how old are you? I ask because I have not been able to get treatment in Atlanta. I'm 72. Just wonder if they limit the good interventions to younger people now. Lastly, where did you find these amazing doctors?

Jump to this post

There are several MDs in Brunswick, GA that promote them. That's where I had mine implanted @ age 68. Five other people I know got them and only one was younger than I.

REPLY
@jager5210

Wow! Good for you. Approximately how old are you? I ask because I have not been able to get treatment in Atlanta. I'm 72. Just wonder if they limit the good interventions to younger people now. Lastly, where did you find these amazing doctors?

Jump to this post

I had my first SCS implanted at age 68 and an updated version just last July at age 74. I am loaded with Degenerative Disc Disease, small fiber neuropathy, and Complex Regional Pain Syndrome in both feet and left knee. I consider myself fairly active despite my conditions. If it ever stops raining in the northeast I look forward to gardening. I am doing more in containers than the ground as it is easier on me. My husband has dementia and I care for him at home. My 15 year old granddaughter keeps me on the go when she comes. I will admit to using a power chair in the house simply because of the painful feet. I just had a sural nerve injection to calm down the pain in one foot with another scheduled for my other foot. I am fortunate to have a superior pain management doctor.

REPLY

What is the best implant for leg pain? I have heard about high frequency equipment that does not generate the 'tingle' feeling that most stimulators do. Is that a better system than the "standard" Spinla Cord Stimulator?

Roy L. Sparks

REPLY
@royboy44

What is the best implant for leg pain? I have heard about high frequency equipment that does not generate the 'tingle' feeling that most stimulators do. Is that a better system than the "standard" Spinla Cord Stimulator?

Roy L. Sparks

Jump to this post

I have a Boston Scientific Stimulator. I now have silent on all my programs which runs all the time. I have the choice of having sensations or not. I prefer to use the sensations during the day. At night I just need to ramp down the sensations to the silent area.

REPLY

This is the device I'm scheduled to get on Aug 28 – the trial for one week, then the permanent stimulator implant. I did the psych eval already – the psychologist told me a lot about the procedure and the theory behind its invention. It's for the pain of advanced neuropathy in feet and legs (it's going up my back too). Thank you, all of you, for posting information and experience. Peggy

REPLY
@pfbacon

This is the device I'm scheduled to get on Aug 28 – the trial for one week, then the permanent stimulator implant. I did the psych eval already – the psychologist told me a lot about the procedure and the theory behind its invention. It's for the pain of advanced neuropathy in feet and legs (it's going up my back too). Thank you, all of you, for posting information and experience. Peggy

Jump to this post

I was told that my device would be a "home run" for my foot neuropathy but probably not work for my back pain. Instead, it did nothing for my feet but I no longer have back pain. Go figure!

REPLY
@royboy44

What is the best implant for leg pain? I have heard about high frequency equipment that does not generate the 'tingle' feeling that most stimulators do. Is that a better system than the "standard" Spinla Cord Stimulator?

Roy L. Sparks

Jump to this post

I have a Nevro high frequency stimulator. It give me no noise or sensation such that I often forget to charge it until my back starts to hurt.

REPLY
@barbbie

I had my first SCS implanted at age 68 and an updated version just last July at age 74. I am loaded with Degenerative Disc Disease, small fiber neuropathy, and Complex Regional Pain Syndrome in both feet and left knee. I consider myself fairly active despite my conditions. If it ever stops raining in the northeast I look forward to gardening. I am doing more in containers than the ground as it is easier on me. My husband has dementia and I care for him at home. My 15 year old granddaughter keeps me on the go when she comes. I will admit to using a power chair in the house simply because of the painful feet. I just had a sural nerve injection to calm down the pain in one foot with another scheduled for my other foot. I am fortunate to have a superior pain management doctor.

Jump to this post

A sural nerve injection? I want some of those! I will ask my pain doctor. Peggy

REPLY
@scruffy1

I have a Nevro high frequency stimulator. It give me no noise or sensation such that I often forget to charge it until my back starts to hurt.

Jump to this post

Where did you get the Nevro HF stimulator? And what Dr. and hospital put it in?

REPLY
@royboy44

Where did you get the Nevro HF stimulator? And what Dr. and hospital put it in?

Jump to this post

Dr. Raymond Topp in Brunswick, GA. He puts them in at a private surgical center. He hooks you up with the Nevro people who are with you during the procedure and monitor you daily for the 1st weeks.

REPLY

I've been out of Mayo Connect for a couple of years, but I decided to jump in to this discussion.

I had a Burst DR spinal cord stimulator implant two years ago and found amazing relief for the pain in my feet from small fiber idiopathic peripheral neuropathy. I estimated an 80% reduction in the burning pain. I have tried all of the medications for neuropathy, and lots of off label meds, with very limited success. Lyrica helped but the side effects put me in the hospital. Recently I tried desipramine, and it was helping with the pain, but caused bladder issues – urgent need to urinate up to 24 times a day – end of yet another medication. I've been taking morphine sulfate contin for a number of years, and I know it helps me manage the pain.

I've been meeting with the Abbott tech every three months or so, to adjust the settings on the controller, because I was having increased pain. I met him again last month, and I seem to be getting the message that the stimulator is losing its efficacy. I rate the pain most days on a scale of 1-10 and lately I've been having more 7 and 8 days.

Some of you know from personal experience the interaction between chronic pain and mental ill- health, especially with depression and suicidal ideation. The interaction is very real. I'm alive today because of the good health professionals who have been treating me for 15+ years.

I'm going to see a neurosurgeon at the end of this month to discuss the possibility of a dorsal root ganglion stimulator. My understanding is that it can do a better job of targeting specific pain. I'm ready to try something new because my pain is increasing and is interfering with my ability to function. My pain specialist is prescribing yet another medication for me to try, but by now I don't hold out much hope.

I had surgery on my ankle in April, because I was rolling my foot more and more often, with more and more pain that would last longer. It was a Brostrom procedure, with a placement of a permanent internal ankle brace. I'm still recovering from that, but I'm pretty sure it will prevent me from further ankle inversion. The pain I have could be from the last time I rolled it. But the combination of ankle pain and neuropathy pain has been hard.

The point of this post is to learn what others have experienced with regard to the long term efficacy of a spinal cord stimulator. I had hoped that it would be a more or less permanent pain management tool. Maybe it is, maybe it's not.

I appreciate any information you can share.

Jim

REPLY
@jimhd

I've been out of Mayo Connect for a couple of years, but I decided to jump in to this discussion.

I had a Burst DR spinal cord stimulator implant two years ago and found amazing relief for the pain in my feet from small fiber idiopathic peripheral neuropathy. I estimated an 80% reduction in the burning pain. I have tried all of the medications for neuropathy, and lots of off label meds, with very limited success. Lyrica helped but the side effects put me in the hospital. Recently I tried desipramine, and it was helping with the pain, but caused bladder issues – urgent need to urinate up to 24 times a day – end of yet another medication. I've been taking morphine sulfate contin for a number of years, and I know it helps me manage the pain.

I've been meeting with the Abbott tech every three months or so, to adjust the settings on the controller, because I was having increased pain. I met him again last month, and I seem to be getting the message that the stimulator is losing its efficacy. I rate the pain most days on a scale of 1-10 and lately I've been having more 7 and 8 days.

Some of you know from personal experience the interaction between chronic pain and mental ill- health, especially with depression and suicidal ideation. The interaction is very real. I'm alive today because of the good health professionals who have been treating me for 15+ years.

I'm going to see a neurosurgeon at the end of this month to discuss the possibility of a dorsal root ganglion stimulator. My understanding is that it can do a better job of targeting specific pain. I'm ready to try something new because my pain is increasing and is interfering with my ability to function. My pain specialist is prescribing yet another medication for me to try, but by now I don't hold out much hope.

I had surgery on my ankle in April, because I was rolling my foot more and more often, with more and more pain that would last longer. It was a Brostrom procedure, with a placement of a permanent internal ankle brace. I'm still recovering from that, but I'm pretty sure it will prevent me from further ankle inversion. The pain I have could be from the last time I rolled it. But the combination of ankle pain and neuropathy pain has been hard.

The point of this post is to learn what others have experienced with regard to the long term efficacy of a spinal cord stimulator. I had hoped that it would be a more or less permanent pain management tool. Maybe it is, maybe it's not.

I appreciate any information you can share.

Jim

Jump to this post

Hi @jimhd, It is really good to hear from you and how you are doing. Thank you for sharing. I'm hoping others will be able to share their experience with the Burst DR spinal cord stimulator implant. I did see an article from Jan 2019 about the Burst DR stimulator. Have you seen it?

New Data Reinforce Benefits of Abbott's BurstDR™ Spinal Cord Stimulator
https://abbott.mediaroom.com/2019-01-19-New-Data-Reinforce-Benefits-of-Abbotts-BurstDR-Spinal-Cord-Stimulation-for-People-Living-with-Chronic-Pain

John

REPLY
@jimhd

I've been out of Mayo Connect for a couple of years, but I decided to jump in to this discussion.

I had a Burst DR spinal cord stimulator implant two years ago and found amazing relief for the pain in my feet from small fiber idiopathic peripheral neuropathy. I estimated an 80% reduction in the burning pain. I have tried all of the medications for neuropathy, and lots of off label meds, with very limited success. Lyrica helped but the side effects put me in the hospital. Recently I tried desipramine, and it was helping with the pain, but caused bladder issues – urgent need to urinate up to 24 times a day – end of yet another medication. I've been taking morphine sulfate contin for a number of years, and I know it helps me manage the pain.

I've been meeting with the Abbott tech every three months or so, to adjust the settings on the controller, because I was having increased pain. I met him again last month, and I seem to be getting the message that the stimulator is losing its efficacy. I rate the pain most days on a scale of 1-10 and lately I've been having more 7 and 8 days.

Some of you know from personal experience the interaction between chronic pain and mental ill- health, especially with depression and suicidal ideation. The interaction is very real. I'm alive today because of the good health professionals who have been treating me for 15+ years.

I'm going to see a neurosurgeon at the end of this month to discuss the possibility of a dorsal root ganglion stimulator. My understanding is that it can do a better job of targeting specific pain. I'm ready to try something new because my pain is increasing and is interfering with my ability to function. My pain specialist is prescribing yet another medication for me to try, but by now I don't hold out much hope.

I had surgery on my ankle in April, because I was rolling my foot more and more often, with more and more pain that would last longer. It was a Brostrom procedure, with a placement of a permanent internal ankle brace. I'm still recovering from that, but I'm pretty sure it will prevent me from further ankle inversion. The pain I have could be from the last time I rolled it. But the combination of ankle pain and neuropathy pain has been hard.

The point of this post is to learn what others have experienced with regard to the long term efficacy of a spinal cord stimulator. I had hoped that it would be a more or less permanent pain management tool. Maybe it is, maybe it's not.

I appreciate any information you can share.

Jim

Jump to this post

Hi, Jim. I had my first stimulator implanted in 2012. In July of 2018 I had an updated version of my Boston Scientific implanted. I now have all day coverage on a silent level and I can add sensations where and when needed. I am looking forward to a dorsal root implant as I have small fiber neuropathy and complex regional pain syndrome in both feet. I have been told about people who were in wheelchairs able to walk with this implant. I am allergic to most meds. I do use oxycodone when all else fails – all else being stimulator, lidoderm pain patches, lidocaine and prolocaine cream, tens unit. I also have Degenerative Disc Disease and arthritis throughout my spine – top to bottom! Have also been dx with myofascial pain. I wake frequently with pain especially in hips and thighs. I need further investigation into that problem. I have a DO as my PCP and he has healing in his hands in doing OMT. I also have a DO for pain management . He is incredibly talented and knowledgeable about CRPS. I do like my stimulator. I am more active now as I am a caregiver for my husband who has dementia and non -Hodgekins Lymphoma. Our ages are 75 and 80 and I believe it is a miracle that I am functioning as I am. My faith in God sustains and uplifts me. He is nurturing me as I nurture my husband. I love being taken care of by my loving, merciful, generous Father.

REPLY
Please login or register to post a reply.