FAQs on Spinal Cord Stimulation for Cancer Pain

 

Spinal cord stimulation is a proven, safe, and effective way to manage intractable cancer pain. Most cancer patients suffer reduced quality of life due to severe, undertreated pain. About 20 % to 30% such patients do not get significant relief with conventional pain management methods. The high cost of cancer pain treatment also adds to the overall burden. Spinal cord stimulator implant allows cancer patients to have better control over pain ensuring greater, longer relief.

How common is cancer pain?

Pain is common in cancer patients, though not all of them experience it. While the disease in itself the cause of pain in 60% to 70% cases, 30% to 40% patients feel pain during the treatment. It is more widespread in patients with advanced cancer with 90% of them experiencing pain. Cancer pain can be mild to severe. About 70% feel phantom pain after breasts, arms, or legs are removed to contain tumor growth.

The level of cancer pain vary from patient to patient depending on the type of cancer, location of tumors, stage of cancer, and extent of nerve damage caused by the illness or treatment. Psychological factors, such as anxiety, depression, sleep problems, and fear, increase the pain feeling.

How am I affected by cancer pain?

Cancer pain can be both acute and chronic. Acute cancer pain caused by internal damage lasts for a brief period. Long-term changes to nerves due to cancer growth lead to chronic cancer pain.

Cancer pain can be broadly categorized into different types based on the cause and treatment.

  • -Neuropathic pain due to increasing tumor pressure on nerves or damage to nerves by cancer or chemotherapy and radiotherapy.
  • -Bone pain or somatic pain occurs when cancer damages bone tissues
  • -Soft tissue or visceral pain because of cancer causing damage to internal organs and muscles.
  • -Phantom pain following removal of body parts affected by tumor growth.
  • -Referred pain in the vicinity of the cancerous body part.

What are symptoms of cancer pain?

  • Mild to severe pain.
  • Acute pain for a brief period
  • Persistent, constant, and intermittent pain over a long period
  • Nerve pain with burning, shooting, or tingling sensation
  • Aching and throbbing bone pain
  • Sharp, cramping, aching, or throbbing pain affecting organ or muscle soft tissues
  • Phantom pain after cancer surgery
  • Pain after chemotherapy and radiotherapy

What causes cancer pain?

The cause of cancer pain can be traced to the disease itself and treatments to contain or destroy it.

  • The Illness: Expansion of cancerous tumors crush, infiltrate, or increase pressure on bone, nerves, muscles, and body organs and. This constricts blood vessels and obstructs blood and oxygen supply leading to pain. Chemical changes linked to tumors also cause infection and pain.
  • Cancer Treatment: Cancer treatments available are considered the most unpleasant. They cause damage to nerves, inflammation of soft tissues, or injuries that lead to pain flares, joint or muscle pain, neuropathy, abdominal pain, chest pain, bone pain.
  • Chemotherapy is associated with tingling and burning sensation in extremities.

How effective is spinal cord stimulation therapy for cancer pain?

It is observed that 15% to 40% cancer pain is of neuropathic origin and spinal cord stimulation therapy is best suited to contain such pain and assure better relief. Intractable cancer pain in 20% to 30% patients does not respond to powerful opioids. In such cases, spinal cord stimulator implant comes handy. The spinal cord stimulator implantation ensures “90% to 100% pain relief, improved functioning and sleep, and discontinuation of pain medications, sustained through 12 months”, claims a 2008 research.

Spinal cord stimulation is also a better pain relief option for cancer patients not fit to undergo other interventional management approaches due to age or medical condition. The therapy ensures more than 85 to 90 % relief from neuropathic pain and over 60% do not need pain medication after the SCS implant.

A 2013 study shows 73% relief from cancer pain using spinal cord stimulation therapy. In 2010, a study reported in the American Journal of Hospice and Palliative Care found SCS safe, more effective for managing cancer-related chest pain than other conservative and more invasive treatments.

According to 2012 research report, spinal cord stimulator implant prevents chronic neuropathic pain in cancer survivors.

What is a spinal cord stimulator?

Spinal cord stimulator is a pulse-generating device. Approved for medical use, it emits controlled electrical impulses that inhibit pain signal transmission and allow non-pain sensations to overshadow pain sensation.

How does spinal cord stimulation relieve cancer pain?

The spinal cord stimulator delivers customized electrical impulses to the spinal cord through a catheter. These electrical signals alter the firing pattern of pain sensation carrying Aδ and C nerve fibers. As a result, pain signal transmission is inhibited and brain does not receive pain sensation.

Who is a candidate for spinal cord stimulator implant?

Cancer patients suffering from persistent pain can consider spinal cord stimulation therapy, if

  • they are in good physical and mental health to undergo implant surgery
  • they have persistent, severe cancer pain for months
  • they have no painkiller dependency
  • they have no electromagnetic medical device in the body

How is spinal cord stimulation therapy performed?

The spinal cord stimulation therapy requires a patient to undergo spinal cord stimulator device implant. It is an invasive surgery and patients can choose between devices with external and internal batteries.

How is spinal cord stimulator implant performed?

Spinal cord stimulator implant is a two stage process. First, a trial implant, which does not require surgery, is carried on to check the efficacy of the pain relief therapy. If the trial is found to be providing significant pain relief without side effects, an implant surgery is performed.

What is done during the SCS trial?

The cancer patient sleeps under intravenous sedation. Doctors numb the skin above the back just above the buttocks. A needle is put through the skin to reach the spine and a catheter is inserted into the needle. The other end of the catheter is connected to a spinal cord stimulator, which is programmed to deliver electrical pulses based on the patient need.

The device is wrapped around the waist of the patient and switched on. It delivers electrical pulses to the spine through the catheter.

How long does the SCS trial take?

The trial implant is performed within 60 to 90 minutes. The device remains wrapped around the waist for a week and the cancer pain relief is assessed.

How is a spinal cord stimulator implanted?

A cancer patient is recommended for permanent spinal cord stimulator implant if he or she has 50% cancer pain relief during the trial. The implant is an invasive procedure and it is performed under general anesthesia.

Doctors numb the skin just above buttocks and do surgical intervention to clear bones and create place for the SCS device. The tiny device is programmed and placed inside. It is connected to a catheter that pierces through soft tissues to reach the spine. The device is tested for pulse delivery and the incision is closed. Skin above is bandaged.

How long does the SCS implant surgery take?

The spinal cord stimulator implant surgery takes about 2 to 3 hours.

What should I expect after the spinal cord stimulator implant?

There will be relief from cancer pain as soon as the implant is done. But the degree of pain relief is fluctuating. It stabilizes after 72 hours indicating the actual long-term relief. Patients feel numbness and soreness at the place of surgery for a week.

What are post-surgical precautions to follow?

  • Keep the incisions clean and dry
  • Take rest for a week
  • No activities or movement likely to put pressure on implant for 6 weeks
  • No activity requiring you to bend or twist for 6 weeks
  • Avoid stressful activities for 6 weeks

How long is the post-SCS implant recovery?

By the end of the first week, patients experience significant relief from cancer pain. They can return to their regular work and do all activities except those likely to impact the implant site. No stressful activity, such as running, swimming, aerobic exercises should be performed in the six weeks following spinal cord stimulator implant.

How long does a spinal cord stimulator last?

A spinal cord stimulator remains for about 20 years offering continued pain relief.

Do I need to replace spinal cord stimulator?

There is no need to replace a spinal cord stimulator unless you have complications. However, you may have to replace batteries of the device to have continued relief from cancer-related pain. A stimulator is available with both internal and external batteries. External batteries are wrapped around your waist and easy to change. Internal batteries require surgical intervention to be replaced.

How often is the battery replaced?

Spinal cord stimulator battery lasts between 3 to 10 years.

What are complications associated with spinal cord stimulation therapy?

Spinal cord stimulation is a safe procedure to treat cancer pain. However, surgical implantation may lead to complications, including infection, bleeding, scar tissue formation, spinal fluid leakage, and bladder disorder. Those with the device can not undergo magnetic resonance imaging (MRI) tests.

References

Lihua P, Su M, Zejun Z, et al. Spinal cord stimulation for cancer-related pain in adults. Cochrane Database System Review. 2013, 28(2), CD009389.

Yakovlev AE, Resch BE, Karasev SA.Treatment of cancer-related chest wall pain using spinal cord stimulation. Am J Hosp Palliat Care. 2010 Dec;27(8):552-6.

Yakovlev AE, Ellias Y. Spinal Cord Stimulation as a Treatment Option for Intractable Neuropathic Cancer Pain. Clin Med Res. 2008, 6(3), 103-106.

Flagg A, McGreevy K, Williams K. Spinal cord stimulation in the treatment of cancer-related pain: “back to the origins”. Curr Pain Headache Rep. 2012 Aug;16(4):343-9.

Lee MG, Choi SS, Lee MK, et al. Thoracic spinal cord stimulation for neuropathic pain after spinal meningioma removal: a case report. Clinical Journal of Pain 2009;25(2):167–9.

Cata JP, Cordella JV, Burton AW, et al. Spinal cord stimulation relieves chemotherapy-induced pain: a clinical case report. Journal of Pain Symptom Management 2004;27(1):72–8.