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

@jimhd Hi there Jim!!! I was wondering and so appreciate your update. I have not been around as much either due to health issues. I check in from time to time.

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Hello all. August marks the end of my second year with an SCS. I had a Nevro HF10 SCS implanted mid-August 2017 at the age of 68. On a daily basis, I have no back pain. About once a month my sacrum gets out of alignment and my chiropractor, who is aware of my SCS and works around it, puts it the sacrum) back into position and, after some ice, I'm back to no pain. Prior to the implant and while under chiropractic care, I needed heat every morning for a hour or two and my freezer was filled with ice/cold packs. Occasionally I am reminded of how well it works when I forget and go for 3+ days without charging it, and I begin to feel pain. The last time took more than 3 hours to get a full charge! My only concern is that the battery seems to take more time to charge than it did when I first got it. It was 15-20 minutes a day but is now like 25 or more. I'd like to get at least 5 years out of this battery. Unfortunately for me, 4 months after my implantation, a new, smaller battery was FDA approved, but I'm not certain I'd have waited because the smaller battery/device is not the least bit uncomfortable. I feel absolutely no sensation from the stimulation, another reason I forget to charge it.

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@johnbishop

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

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Thanks for the link. I just read that article a couple of days ago.

I turned my stimulator off on Sunday morning to see if it's actually helping in reducing the burning pain in my feet. I didn't notice any difference until today. I think the pain is a little worse, but it's hard to know because they always hurt more when I'm on my feet very much. I think I'll have to give it more time to really know. If it gets too bad I'll turn it back on.

Lidocaine cream numbs the pain for a couple of hours. I mostly use it at bedtime to get to sleep, but I don't use it very often because it's so expensive. I save it for the really bad nights.

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@jimhd What % lidocaine cream are you using? I have 2.5% lidocaine and 2.5% prilocaine combined for under $10 with insurance

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@scruffy1

@jimhd What % lidocaine cream are you using? I have 2.5% lidocaine and 2.5% prilocaine combined for under $10 with insurance

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The lidocaine cream I use is 5%. I've tried Capzasin several times but it had no effect on the neuropathy pain. It must help some people, or my pain specialist wouldn't have recommended it. I found out that even though I wash my hands thoroughly, if I touched my eye it burned – really burned, and for quite a while. I decided that if I give it another try I'll use latex gloves. The lidocaine is a prescription, of course. I think I'll try the OTC cream and see if it does anything.

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@jimhd, I checked…mine was a $5 prescription. CBD/hemp oil worked for me for a month or so, then no relief. Go figure. The company that made it is apparently OOB and the current supplier's stuff doesn't work…or I've habituated to it.

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@scruffy1

@jimhd, I checked…mine was a $5 prescription. CBD/hemp oil worked for me for a month or so, then no relief. Go figure. The company that made it is apparently OOB and the current supplier's stuff doesn't work…or I've habituated to it.

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I tried making brownies with some cannabis butter, but I didn't like the taste. It didn't help with the pain, just made me feel loopy. I haven't tried CBD oil, though lots of people swear by it. I keep hoping one of my doctors will come up with a medication that I can take without bad side effects. I'm going to talk with a neurosurgeon in a few weeks about a different stimulator. I don't know much about it yet, but the man who has been working with me adjusting the controller seems to think it might be a better solution for me. We shall see.

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Klonopin reduced my pain by more than 50%, but last year DEA forbade docs to prescribe it in concert with the pain meds I take, so I had to quit taking it. Haven't felt right since.

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@scruffy1

Klonopin reduced my pain by more than 50%, but last year DEA forbade docs to prescribe it in concert with the pain meds I take, so I had to quit taking it. Haven't felt right since.

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Hello @scruffy, the DEA didn't forbid it, just warned it was possibly dangerous. The same with other drugs like ambien. Maybe recheck with your doctor.

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@scruffy1

Klonopin reduced my pain by more than 50%, but last year DEA forbade docs to prescribe it in concert with the pain meds I take, so I had to quit taking it. Haven't felt right since.

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@scruffy1 Some of decisions and restrictions are done at the state level. Here in Oregon last year the governing physicians board required doctors to prescribe only 100mg of narcotics. Some adjustments to the ruling were made to accommodate those who need it for chronic pain long term. The same regulations apply to pharmacies, as well. At first they were limiting prescriptions to, if I remember correctly, ten days worth, and even less for post surgery pain. I'm glad they figured out how incredibly difficult it would be, especially for someone who lives 200 miles from the nearest pharmacy. As it is, they are only allowed to prescribe narcotics for a 30 day supply. Even that can be a challenge. I drive 30 miles to do my shopping, and I have to be careful not to cut it too close and risk running out. My wife and I are probably going to be able to drive for awhile, but I don't want to think about what we'd do to get to town. Everyone talks about getting rid of cars and using public transportation. Yeah right. Like that will ever happen where we live out in the country.

I began taking 1mg, with the option of taking 2 a day, 15 years ago for anxiety. A secondary benefit is that I don't kick and punch, acting out my dreams. It's one medication my wife doesn't want me to stop taking.

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@jimhd , that's insane, especially for post-operative pain.. Federal law allows narcotic pain relievers for 30-day periods. My physiatrist (MD of physical medicine) (or his P.A.) sees me every 60 days and give me 2 prescriptions: one for that month and one for the next month, and they are dated specifically for those months. That saves a trip. And, randomly, I'm tested to see if I'm actually taking the drugs (and not selling them) or if I'm taking them from two sources. It's a minor inconvenience that I'm used to. When I worked I also had to take the tests. One thing that I noticed: my neuropathy was far worse when I was under stress. My pain level seems to follow my stress levels, so if I can find a way to relax or exercise to get rid of stress, I hurt less, sometimes significantly less. That's why the benzos (that I may no longer take) kept my pain levels VERY manageable. Sometimes pain causes stress which causes pain which causes more stress and more pain. I try to eliminate that first stressful situation.

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@scruffy1

@jimhd , that's insane, especially for post-operative pain.. Federal law allows narcotic pain relievers for 30-day periods. My physiatrist (MD of physical medicine) (or his P.A.) sees me every 60 days and give me 2 prescriptions: one for that month and one for the next month, and they are dated specifically for those months. That saves a trip. And, randomly, I'm tested to see if I'm actually taking the drugs (and not selling them) or if I'm taking them from two sources. It's a minor inconvenience that I'm used to. When I worked I also had to take the tests. One thing that I noticed: my neuropathy was far worse when I was under stress. My pain level seems to follow my stress levels, so if I can find a way to relax or exercise to get rid of stress, I hurt less, sometimes significantly less. That's why the benzos (that I may no longer take) kept my pain levels VERY manageable. Sometimes pain causes stress which causes pain which causes more stress and more pain. I try to eliminate that first stressful situation.

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@scruffy1 My doctor gave me dated prescriptions for 3 months at a time. At least the laws have changed so that he can send a prescription electronically now, so I no longer have to go to the doctor's office and pick up a hand written one and take it to the pharmacy. I get most of my medications from Humana Pharmacy mail order, which is really convenient, but I have to stay on top of refill dates and to send a message to the doctor to send in the monthly scrips. I got behind on one this week and I had to go to the local Rite Aid for a ten day supply to hold me over until the mail order 3 month scrip comes.

Pain certainly does exacerbate stress and depression, and vice versa. I know from my experience over the past 15 years. I had six appointments with a pain therapist who made some recommendations for living with and managing pain. I wasn't so sure about some of what she said, but I have been practicing a couple of things I learned from her.

Jim

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@jimhd

@scruffy1 My doctor gave me dated prescriptions for 3 months at a time. At least the laws have changed so that he can send a prescription electronically now, so I no longer have to go to the doctor's office and pick up a hand written one and take it to the pharmacy. I get most of my medications from Humana Pharmacy mail order, which is really convenient, but I have to stay on top of refill dates and to send a message to the doctor to send in the monthly scrips. I got behind on one this week and I had to go to the local Rite Aid for a ten day supply to hold me over until the mail order 3 month scrip comes.

Pain certainly does exacerbate stress and depression, and vice versa. I know from my experience over the past 15 years. I had six appointments with a pain therapist who made some recommendations for living with and managing pain. I wasn't so sure about some of what she said, but I have been practicing a couple of things I learned from her.

Jim

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Hi Jim. I live in Az and I take opioids, and have been told by my pain Mgmt Dr as well as my pharmacist that I can only get a 30 day supply. So I have to go monthly and give urine so they can verify that I’m using it and not taking it and selling, then they send an electronic script. I wish I could get a 2-3 month electronic script. Where do you 2 live that’s allows this? Also, are the scripts for controlled substances? That’s my roadblock to not being able to get a 90 day supply. Frustrating. Thx.

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@mlross4508 I thought that no electronic opioid prescriptions was a DEA or FDA reg. When I go to the pain doc, I can only get a current 30-day prescription and another dated 30 days from the first.

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@tjp4

Hello @scruffy, the DEA didn't forbid it, just warned it was possibly dangerous. The same with other drugs like ambien. Maybe recheck with your doctor.

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@tjp4 Thank you for the info. My doc said that every time he prescribes it knowing I'm on opioids, he gets a "strike." 10 "strikes" and he says he can lose his DEA license. My next visit is with him, not his P.A. I'll see what he says. Life has been miserable without the Klonopin. I wear a Herbst appliance for sleep apnea, and it causes dry mouth. I have Biotene (recommended by someone on this website…and a GREAT recommendation) on my night table but my initial sleeping is still about 2-3 hours. Then it's Ambien and hope to get 4 more. With Klonopin, I got 8-10 hr. and little foot pain. The difference was so stark when I forgot to take it that I knew by late the next morning that I missed it, my feet hurt so much.

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