Spinal Cord Stimulation: An Option for Chronic Pain

There are many reasons a person can be in pain. For most people, this pain will improve with time or limited medical treatment. There are cases, however, in which the pain does not improve and is then called “chronic.’’

How to manage chronic pain

There are many ways to manage chronic pain. Some methods of treating pain are non-invasive, such as physical and occupational therapy or medications. Then there are more invasive options, such as injections and surgery, which are commonly used for conditions that seem to have a defined source.

These methods can usually achieve manageable levels of pain. For people with chronic pain that does not respond adequately to these methods, spinal cord stimulation may be a good option.

Spinal cord simulation

A spinal cord stimulator is an implantable device that sends small electrical signals to your spinal cord to block pain signals from reaching your brain. These devices utilize wires, called “leads,’’ that are safely inserted into the epidural space near the spinal cord and a battery that generates the electrical stimulus. The process is broken down into two parts, a “trial” and an “implant.’’ These steps are both done on an outpatient basis, and the patient returns home the same day. Patients undergoing these procedures usually receive some form of sedation and are, therefore, very comfortable. Spinal cord stimulators are very effective for nerve pain that moves down one or both legs and can also help with lower back pain. Spinal cord stimulation is also effective for diabetic peripheral neuropathy, failed back surgery syndrome and complex regional pain syndrome.

Spinal cord stimulation uses different types of technology, such as low-frequency or high-frequency settings. The lower frequencies may provide a pleasant tingling sensation that is felt by the patient and decreases the pain signals being felt. Other low frequencies may not be felt by the patient but continue to provide pain relief. High-frequency settings would provide pain relief with no tingling sensations and work on different areas of the spinal cord compared to the low frequency. Most current spinal cord stimulation companies provide some form of high- and low-frequency options.

The first part of the process, called a “trial,’’ is temporary and fully reversible. It is done using only needles and does not involve any incisions or stitches. The leads (or wires) exit the body through the skin and are connected to an external battery. The purpose of the trial is to make sure that a patient gets an adequate amount of relief before undergoing a permanent implant. The trial lasts for a few days, during which the patient works with a representative of the device manufacturer to optimize the device settings to get the maximum amount of relief. At the end of the trial period, the patient returns to the doctor’s office to discuss the effects of the device and to have the trial leads removed. Removing the trial leads is usually painless. If the patient had very significant relief during the trial period, then they can choose, if they wish, to have the device permanently implanted.

The second part, called an “implant,’’ is very similar to the trial but does require some incisions. The implant is intended to be permanent and is a surgical procedure. After the implant is complete, both the leads and the battery are completely beneath the skin. Initially, there are some activity restrictions to allow for the incisions to heal and to prevent the leads from moving out of place. After a period of time, the incisions should be healed, and the leads should be scarred down and less likely to move. After this period, the patient should be able to resume their usual activities. With the implanted device now in place, the patient should experience less pain and a higher quality of life while relying less on oral medications to treat their pain.