Electronic Spinal Cord Stimulation

Q. I’ve heard of doctors using electronic spinal cord stimulation for chronic pain. What is it, and how do I know if it’s right for me?

A.  The issue of living with chronic pain has become a hot topic in America. Just turn on the television and view the multitude of commercials for medications and various devices that claim to reduce pain. In fact, chronic pain is such a common complaint that one in 10 Americans report they have had pain lasting for more than one year. And a full 25 percent of Americans say that they have had low back pain lasting for three or more months. Fortunately, our understanding of the complex nature of chronic pain has increased, and medical technology has improved to provide new ways to address chronic pain.

One promising treatment for pain control is spinal cord stimulation (SCS), also known as neurostimulation or neuromodulation therapy. Although SCS has been in use since the 1960s, the technology has advanced in recent years to become a very effective means of controlling pain. SCS has been approved by the U.S. Food and Drug Administration and has been shown in medical research to not only reduce pain, but also to improve functional ability and quality of life. Additionally, SCS provides an alternative for pain relief in patients for whom surgery is not recommended. In fact, for some patients, SCS has been shown to be more effective than repeated surgery.

How It Works

Spinal cord stimulation uses a thin cable, or lead, to deliver low-level electrical impulses to the spinal cord. These impulses interfere with the signaling of pain between the spinal cord and the brain. The lead is placed into the epidural space around the spinal cord and is then attached to a generator, which can be controlled with a hand-held programmer. The generator size varies but is typically palm-sized or smaller. This generator produces an electrical impulse, which the patient experiences as a tingling or tapping sensation and which replaces the feeling of pain. The patient can adjust the impulse with personalized, preset programs, which are focused on the areas where the patient typically experiences pain. The device can be turned on and off, the sensation intensity turned up or down, and the area of coverage adjusted. These are valuable features as pain can be felt at different times at varying intensities or even in different locations.

Spinal cord stimulation is used for treatment of chronic or intractable pain—pain that simpler measures, such as medications or physical therapy, cannot control. Not only is it an effective method of pain control for many patients, but it may also reduce the need for medications. This is an important feature, as pain medications are often limited in their use because of side effects, such as sedation. Another benefit is that SCS is usually performed first as a trial. The lead is placed in the epidural space and connected to an external generator. The length of the trial period varies but is typically five to seven days. This allows the patient to try the device to determine what benefit it provides. After the trial period, the patient can decide if he or she would like to proceed with the device. If so, the stimulator is implanted through minor surgery. SCS is less invasive than many surgical options and can be reversed.

Many patients who benefit from SCS have spine or spine-related conditions. These include radiculopathy (also called pinched nerves or sciatica) and failed back surgery syndrome—a term used to describe patients who have had correction of an anatomical problem through surgery but continue to have significant pain. Two types of failed back surgery syndrome that may benefit from SCS are epidural fibrosis and arachnoiditis. Epidural fibrosis refers to the development of scar tissue which can compress the nerves as they exit the spine. Arachnoiditis is inflammation of the tissue covering the nerves. Both can cause severe pain and even weakness. Spinal cord stimulation is also frequently effective for patients with complex regional pain syndrome (CRPS), also known as reflex sympathetic dystrophy (RSD). In this disorder, the body exhibits an exaggerated response to an injury, and the pain response may be perpetuated by the nervous system itself.

To best determine if you are a candidate for SCS, consult a physician who is knowledgeable about chronic pain as well as SCS therapy. Like all medical procedures, SCS is not appropriate for everyone; however, it is a very effective pain-control alternative for many patients. SCS has improved the lives of many patients and allowed them to return to the activities that matter to them most.

Written by Dr. Jenny Andrus