Spinal cord stimulators are a relatively new and novel intervention for the treatment of chronic pain that fails to respond to other treatment modalities. The implant used in spinal cord stimulation is also referred to as a spinal cord stimulator (SCS). It is a pulse generator that is surgically implanted under the skin of the abdomen or in the buttocks.
The implant is connected to the spinal nerves through electrodes that can count from 4 to 16, depending on the severity of the case. The SCS delivers low voltage stimulation of the spinal cord, which interferes with the transmission of pain signals, thus providing relief of pain symptoms. This may not totally eliminate the pain, but typically reduces it substantially. Patients describe the sensation of spinal cord stimulation as a tingling, or buzzing sensation – this is a relative relief from the chronic pain that they suffer, although some patients may be unable to tolerate this sensation.
The most commonly used types of SCS implants fall into three general categories:
- Conventional systems are the most commonly implanted SCS devices. The main advantage of conventional systems is the low maintenance requirement for battery replacement: this is only done every two to five years, and requires a minor surgical procedure.
- Radiofrequency (RF) systems require an external power source. They are used in cases of severe, intractable pain, and for cases of complex, multi-extremity chronic pain. RF systems are able to deliver higher levels of energy and sustained stimulation.
- Rechargeable systems allow the patient to recharge the battery independently. However, replacement of components will still be needed if they wear out.
The exact schedule of use will depend on the specific circumstances surrounding each case, as well as the patient’s tolerance and response to the stimulation. A typical schedule of SCS would be to turn it on for one to two hours per session, with three to four sessions in one day.
SCS implantation has been reported to be generally successful, with some studies indicating that 40 to 70 percent of patients who undergo the procedure will experience significant reduction in pain symptoms. SCS implants have been shown to provide significant improvements in functionality, and return to activities of daily living.
There are numerous conditions that can benefit from SCS implantation, but generally, this is preferred as a therapeutic intervention for chronic (at least six months) pain that has failed to respond to conservative techniques, and pain that persists despite surgical treatment. In particular, SCS has been used to successfully treat conditions such as:
- Failed back surgery syndrome
- Chronic regional pain syndrome
- Chronic back or leg pain
- Chronic peripheral neuropathy
- Multiple sclerosis
- Phantom limb pain
Boulder pain management doctors have also demonstrated that SCS can be applied for other conditions, such as refractory angina pectoris, Parkinson’s disease, and chronic abdominal or pelvic pain. However, more research is required to prove the effectiveness of these novel interventions.
Despite the promise of SCS implantation, patients must be kept aware of the risks associated with the procedure, such as infection, bleeding, and intraoperative damage to the surrounding nerves and tissues.