steeldove
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Spinal Cord Stimulation
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
scruffy1
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I sure hope the rest of the U.S. can do what Oregon is doing!
A sad part of this opioid problem is that those of us that need them have to fight to get them and be inconvenienced doing so. About 20 years ago when they first proposed these restrictions, I wrote to the Administrator of DEA, with whom I worked when she was a federal prosecutor, and told her of the difficulty my father would have getting to a doctor every month (he usually had 5 refills). I rec'd a reply that they weren't going to institute the proposed changes. Well THEY didn't but they also didn't see the truck coming down the road. Now we're stuck with this for the foreseeable future.
pfbacon
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I'm near Washington DC, I get prescriptions filled in Delaware and Virginia, I went to pick up the Tramadol last month and they only gave me 7 and said that my insurance company now only approves 7 a week and I would have to come back every week and get 7 more. Such inconvenience. This insurance company knows that I only take 1/2 of a tablet whenever nothing else works – I have never refilled Tramadol in less that 5 or 6 months. Insurance companies aren't doing this to 'save us from addiction', they have figured out that if they take every opportunity to harass all of their clients, some clients will skip refilling medications and the company will save money. This real/or/phony 'opioid epidemic' gives them an excuse to hold up everyone's pain meds. Peggy
donw101@aol.com
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Jim, Alumni Mentor
@jimhd
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Teresa, Volunteer Mentor
@hopeful33250
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@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
Hi @jimhd, I'm so pleased to be reading your posts! I've wondered how you were doing. So good to hear from you again.
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pfbacon
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I was supposed to go into the hospital this Friday and get a trial stimulater put into my back but I chickened out. The 1 week prep and 1 week recovery was not do-able for me, plus, the last 2 times I was hospitalized it was a nightmare – they way over-stepped their bounds. I'm afraid they won't take care of me. Peggy
Jim, Alumni Mentor
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@pfbacon I was supposed to go into the hospital this Friday and get a trial stimulater put into my back but I chickened out. The 1 week prep and 1 week recovery was not do-able for me, plus, the last 2 times I was hospitalized it was a nightmare – they way over-stepped their bounds. I'm afraid they won't take care of me. Peggy
I'm sorry you've had difficulties with hospitals. My trial and the permanent implant were done at a surgery center as outpatient. I don't know why one would have to be admitted for either procedure. Do you like the surgeon? Do you have experience with him/her in the past?
I never met the surgeon until I was in the little cubicle pre op, and have never seen him since then. I won't be having him do anything else for me. I should have done some research. Maybe that wouldn't have helped.
The hardest thing for me was having to do next to nothing for 6 weeks after the implant. I had no pain to speak of. I'm thin, so there's no cushion to pad the generator and even now, two years later, it can be a little uncomfortable lying on that side, or sitting in some chairs. It doesn't hurt at all. I had the doctor put it on the left side of my back, above the belt line.
Is it possible to look at other surgeons who would do it outpatient and not in a hospital?
One thing that disturbs me is that an Abbott tech is the only one who sees me whenever I need to have the generator adjusted. I've read that in some cases either a doctor or a nurse is always present, and if I had it to do over again, I'd ask a lot more questions, and probably interview any doctors in the area who do the procedure.
I read in the literature from St. Jude that occasionally a patient might spend the night after the implant, but it certainly wasn't necessary in my case. St. Jude was the originator of the Burst DR stimulator, and soon after I got mine, Abbott took it over. I chose the Burst DR because it advertised that it's MRI compatible. Well, that isn't quite true. I went to get an MRI a few months ago and the controller said "MRI not advised". I am not happy about that. Supposedly the company is working on an update that will make it MRI compatible, but it's taking them a lot longer to do that than the tech promised. The neurologist wants to see a brain MRI that's higher resolution than ones I've had in the past.
I guess my lesson is to better learn patience.
Jim
REPLY
Jen, Volunteer Mentor
@sandytoes14
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@pfbacon I'm near Washington DC, I get prescriptions filled in Delaware and Virginia, I went to pick up the Tramadol last month and they only gave me 7 and said that my insurance company now only approves 7 a week and I would have to come back every week and get 7 more. Such inconvenience. This insurance company knows that I only take 1/2 of a tablet whenever nothing else works – I have never refilled Tramadol in less that 5 or 6 months. Insurance companies aren't doing this to 'save us from addiction', they have figured out that if they take every opportunity to harass all of their clients, some clients will skip refilling medications and the company will save money. This real/or/phony 'opioid epidemic' gives them an excuse to hold up everyone's pain meds. Peggy
Peggy, I read that your pharmacy fills Tramadol for 7 days. Your doctor must write NON ACUTE PAIN on the Rx. This is the new Federal standard for Chronic Pain. Then you can get 30 days supply. Awful, isn't it?
REPLY
barbbie
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@pfbacon I was supposed to go into the hospital this Friday and get a trial stimulater put into my back but I chickened out. The 1 week prep and 1 week recovery was not do-able for me, plus, the last 2 times I was hospitalized it was a nightmare – they way over-stepped their bounds. I'm afraid they won't take care of me. Peggy
What preparation was required? I've had two trials and two implanted. My second implant I had problems because of the Jackson table and the throwing around of my body. I did spend two nights in the hospital.
donw101@aol.com
@donw200
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@laylabug 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.
What is the make of your SCS?
pfbacon
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@sandytoes14 Peggy, I read that your pharmacy fills Tramadol for 7 days. Your doctor must write NON ACUTE PAIN on the Rx. This is the new Federal standard for Chronic Pain. Then you can get 30 days supply. Awful, isn't it?
Jen, thank you for that tip! Yes, it is awful … I wouldn't take Tramadol at all if the pain wasn't acute! Peggy
kimspr3
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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
I had the stimulator and I did find relief. There are a few types they offer meaning the kind of stimulation that feels good. I chose a constant vibration. After the implant patient is assigned to a Rep. from the Company, they will offer you different setting.
resawaller
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donw101@aol.com
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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
Fred, I tried the Boston Scientific trial version and it did help —completely helped me with my foot nerve pain.
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@jimhd
In reply to @mlross4508
@mlross4508
I think it's been a year since I could get scrips dated for the next two months. Now I have to send my PCP a request every month for morphine sulfate contin and Klonopin. He can now send an electronic prescription for my medications that are controlled substances. I used to have to call the doctor to get a renewal, then drive to town, pick it up, and hand deliver it to the pharmacy. It's so much simpler to have the doctor send the e-prescription to my mail order pharmacy. I still have to sign for it when Fed Ex delivers it.
That's the way it works in Oregon.
Liked by Teresa, Volunteer Mentor