Spinal Cord Stimulator has become an invaluable tool for the treatment of chronic intractable pain. Its first documented use was in 1967. Since then the evolution of modern technology it has become more practical, simple to implant and use. It is used for the patients who have pain in spite of different treatment, therapy r surgery. The most common use of spinal cord stimulator is chronic low back pain with or without radiation to lower extremities. It can be placed prior to or after the back surgery, which has failed to provide adequate pain relief. Other common painful conditions in which spinal cord stimulator provide pain control include certain shoulder and upper extremity pain, complex regional pain syndrome (R.S.D. or causalgia) and pain caused by vascular insufficiency including intractable angina. Other less common use of spinal cord stimulator includes pain caused by post-herpetic neuralgia (shingles) and phantom limb pain.
Placement of spinal cord stimulator involves careful screening of patients with emphasis on detailed medical history, prior therapy, prior surgeries and a psychological evaluation and education on how the system operates. Its placement is a two part procedure. First part involves placement of trial electrodes in the epidural space (similar to epidural catheter placed during childbirth). It is done under the X-ray guidance with patient sedated and relaxed. Electrode position is adjusted and patient is asked to tell if the stimulation is felt in the same area as the pain. Once all the painful areas are covered by this buzzing sensation, then the electrodes are connected to an external pulse generator which the patient can operate. Once the patient is comfortable with its use, he is discharged hone to resume his holiday routine. This trial usually lasts 5 days and patients are asked to keep a daily diary noting the pain intensity with spinal cord stimulator on and off. This is the time when patients decide whether they are getting enough pain relief to warrant a permanent placement of the spinal cord stimulator. Generally a 50% or more reduction in pain is considered as a favorable response. The trial electrode is removed at the office and patients are scheduled for the permanent placement if the trial is favorable.
Permanent spinal cord stimulator is a completely implantable system in which the electrodes, pulse generator and the battery are implanted under the skin. The pulse generator is placed in a pocket under the skin. The most common sites for generator placement are lower abdomen or lower back, generally below the belt line. For this part patients receive either local anesthesia with heavy sedation. Once permanent spinal cord stimulator is placed it is programmed to patient’s liking ad patients are discharged on the same day. It is advised that they avoid any excessive bending of back or any other extreme activity. After 6 weeks patients can generally resume their usual activities.
Every procedure has its complications but fortunately serious complications are rare with spinal cord stimulator placement. Most common complications include displaced or disconnected electrode, headache and being an invasive procedure, there is always a risk of infection and bleeding.
If you need any further information about this or any other pain treatment modality, you can reach our Interventional Pain Management specialist.