Spinal Cord Stimulators: A Proven Option for Chronic Back Pain Relief

Understanding Spinal Cord Stimulators for Managing Chronic Back Pain

Back pain is one of the most common causes of disability worldwide. While most back pain resolves within several weeks, some cases become severe or chronic, lasting over 3 months. For those with unrelenting back pain not relieved through conservative treatments, spinal cord stimulators may provide an alternative solution.

What Are Spinal Cord Stimulators?

Spinal cord stimulators (SCS) are medical devices implanted under the skin that send mild electrical pulses to the spinal cord. Though not fully understood, its believed the electrical current interrupts pain signal transmission, providing pain relief. SCS devices consist of:

• One or more electrode leads placed near the spinal cord
• A neurostimulator or generator implant that powers the leads
• A remote control to adjust stimulation as needed

When Are Spinal Cord Stimulators Used?

Spinal cord stimulators are primarily considered for chronic nerve pain after conservative treatments like medication, physical therapy, weight loss, alternative medicine or minimally invasive procedures have failed to provide adequate pain relief. Common conditions treated with SCS include:

• Failed back surgery syndrome
• Degenerative disc disease
• Spinal stenosis
• Radiculopathy
• Peripheral neuropathy
• Complex regional pain syndrome

The SCS Implantation Process and Components

The spinal cord stimulator implantation process typically occurs in two phases - a short-term trial period followed by permanent implantation for those receiving significant pain relief from the trial.

Trial Stage

The trial phase allows evaluation of potential pain relief prior to permanent placement. During an outpatient procedure:

• 1-2 leads are inserted through a small incision near the spine and placed in the epidural space outside the spinal cord.
• Leads are connected to an external trial stimulator secured by adhesive on the skin.
• Over the next 3-10 days, different stimulation settings are trialed to optimize pain relief.

Permanent Implantation

For those experiencing over 50% pain reduction in trial, permanent SCS device implantation may proceed, involving:

• Implanting a small neurostimulator/generator in the buttocks or abdomen.
• Connecting electrode leads from trial under skin to device.
• Programming the device for customized symptom relief.

The generator battery generally lasts several years before replacement is needed.

Components of Spinal Cord Stimulation Systems

Spinal cord stimulators have both implantable and external components working together as a system to block pain signals.

Implanted Components

• Leads - insulated wires with electrodes to deliver stimulation to spinal cord.
• Extension wires - connect leads to neurostimulator device.
• Generator (IPG) - battery-powered device producing and regulating stimulation.

External Components

• Remote controller - allows patient to adjust stimulation within set limits.
• Charger - an inductive belt or adhesive pad charging the IPG battery transcutaneously.
• Clinic programmer - computer used by doctor to adjust IPG settings.

Who is a Good Candidate for Spinal Cord Stimulation?

While spinal cord stimulation can greatly reduce pain for many, results vary by individual as with any medical treatment. Potential candidates include those who:

• Have chronic back/neck pain persisting over a year post surgery or injury.
• Did not achieve adequate long-term relief from medications, therapy, injections, etc.
• Do not have untreated drug addiction or mental health conditions.
• Are not candidates for additional surgery.
• Had positive response to a stimulation trial period.

Contraindications

However for certain patients, spinal cord stimulation may be risky or ineffective:

• Those with bleeding disorders or on blood thinners.
• Pregnant women or those planning pregnancy.
• People undergoing MRI scanning (some devices are now MRI conditional).
• Those unable to properly operate the SCS system.
• Patients diagnosed with an active systemic infection.

Risks and benefits should be carefully weighed before proceeding.

The Pros and Cons of Spinal Cord Stimulators

Like any medical treatment, spinal cord stimulation has both advantages and drawbacks to consider.

Potential Benefits

• Significant chronic pain relief without drugs.
• Enables return to normal function and activity.
• Outpatient procedure with minimally invasive placement.
• Programmable to meet customized needs.
• Reversible - leads can be removed if ineffective.

Potential Risks and Side Effects

• Infection from implant surgery or hardware erosion.
• Uncomfortable stimulation sensations (paresthesia).
• Lead migration over time.
• Limited physical capabilities with generator implant.
• Loss of pain relief over the long term.

However, modern devices and surgery techniques make complications fairly rare in occurrence today.

What to Expect With a Spinal Cord Stimulator Implant

The spinal cord stimulator implantation process - from initial consultation and work-up through recovery - may progress as follows:

1. Evaluation - Medical history review, exam, diagnostic tests to confirm appropriateness for SCS therapy.
2. Pre-op - Routine pre-surgery lab work, medication adjustments, pain treatment modifications.
3. Lead Implantation - Outpatient procedure (about 1-3 hours) inserting electrode leads under sedation/local anesthesia.
4. External Trial Stimulation - Assess efficacy of programming settings for up to 10 days.
5. IPG Implant Surgery - If trial successful, generator is implanted (30-120 mins) as an outpatient.
6. Healing Period - 1-4 weeks for surgical sites to heal before resuming normal activity.
7. Stimulation Programming - Fine tune IPG over multiple follow up visits to manage pain.

With optimal settings and pain control achieved, the SCS provides maintenance relief as long as needed over years.

Long-term Follow Up and Maintenance

Though spinal cord stimulation provides lasting results when effective, periodic follow up and maintenance may include:

• Generator replacement every 3-10 years when battery depletes.
• Occasional reprogramming tune-ups to sustain relief.
• Lead wire adjustments if migration occurs.
• Incision site care and activity modification during initial healing phase.

By closely collaborating with your care team for device upkeep and optimization as needed, SCS therapy can successfully manage chronic intractable back pain over the long term.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.