Chronic pain can be extremely difficult to treat. In most cases, patients are left with the only of option of using medications to help dull the pain but even then, pain continues. As the dose of medications are increased to combat this pain, so does the likelihood of side effects from these medications. At times, the side effects can be worse than the pain it is trying to alleviate. Long term, the same medications prescribed to help with your pain can have untoward effects on your mind and body, especially your liver and kidneys. Patients often turn toward surgery to “fix” the problem, but the majority of the time surgery is not indicated and/or has made the initial pain worse.
Spinal cord stimulation therapy is a treatment option targeted to treating your chronic pain without the use medications. It is meant to decrease your pain by at least 50% while at the same time potentially eliminate the need for chronic medication use and increase your overall functional status allowing you to get back to a normal life. It is often thought of as similar to a TENS unit that is used on the skin to help with muscle pain. However, this therapy differs from a TENS in that it offers a permanent solution to your chronic pain. Even if you have tried a TENS unit and it has not been helpful, does not mean that this therapy will not help you. By “stimulating” different nerve fibers in your spinal cord, this changes the way your body interprets your pain changing it to a tingling sensation. Some of my patients describe it as “a million little fingers massaging my painful area at the same time”. When compared to constant shooting/stabbing/aching/burning pain, for most of our patients, this is a better option.
Different from any surgical procedure, you can try this therapy to determine whether it will help you or not before anything permanent is done. Think of it as test driving a car before actually buying it. If you do not benefit from the initial trial “test drive”, then no surgery is performed “you don’t buy the car”. However, if the trial does decrease your pain by at least 50%, decreases your pain medication use AND increases your walking/sitting/standing/sleeping…., then implantation of this device is right for you. Though it does not cure the underlying disease, it can alleviate your pain.
Other indications include:
- Herniated/bulging discs that are pressing on nerves in your neck and/or low back
- Chronic spinal pain (neck and low back) possibly associated with arm and/or leg pain
- Spinal stenosis
- Degenerative disc disease
- Cervical radiculopathy
- Lumbar radiculopathy
- Any type of nerve pain with or without nerve damage
- Continued pain after spinal surgery
- Pain after shingles has resolved
- Neuropathic pain in the arms and/or legs even from diabetes
- Peripheral neuropathy from any cause
- Poor blood flow in your arms and/or legs
- Chest pain associated with angina
- Continued pain after arm/hand or leg/foot surgery
- Chronic pelvic pain
- Complex regional pain syndrome formerly RSD in your extremities
- Cancer pain
Contraindications/Reasons why you may not have your procedure today:
- Bleeding disorders/low platelet counts
- Medications that thin your blood (please review this section)
- Current infection
- No driver
- Your symptoms have changed and/or improved
- Patient refusal
- Procedure not approved by your insurance
- Poorly controlled high blood pressure that may be giving you symptoms
- Poorly controlled diabetes
- Allergies to the any of the medications that is being used
Potential side effects/risks of the procedure:
- Increased pain
- Numbness in lower extremities that is short lived
- Allergic reaction
- Nerve and/or spinal cord injury
- Lead migration
During the procedure, you will be lying on your stomach. An IV will be started to give you antibiotics prior to the procedure as well as any sedation if needed. An x-ray machine will be used to locate the specific level of the spine where the lead will be placed to best maximize your pain relief. After your skin is cleaned with an antiseptic solution, typically betadine unless you are allergic, a series of x-rays will be taken to guide the needle placement. The skin is then numbed with a local anesthetic which is typically the most painful part of the procedure as this medicine has a tendency to burn when it is injected. After this point, you should only feel pressure. If anything is too painful for you, please tell your physician as more numbing medicine can be given. A needle is then placed through the numb area and when the needle tip is in the epidural space, an electrode will placed through the needle and steered to the level of the spine targeted to where you will get your most pain relief. You may experience increased pressure in your spine which is normal. However, if at any time the pain is too intense, please tell your physician. At times, another lead may need to be placed in your spine especially if you have pain on both sides of your body and/or in the center of your spine. This is done in exactly the same way as the first lead. When the electrode(s) is in the correct position, we will turn on the stimulator to test whether or not it is covering your most painful areas. When the stimulation covers all of your pain, the needle(s) is removed, the electrode(s) are taped to your back and the procedure is over. Often times, you may also need a brace to make sure the lead(s) do not move during your trial. Further programming of your stimulator is performed in the recovery room.
Typical length of the procedure:
30 minutes. Expect to be at the clinic at least 1 hour after you have been checked in by the medical assistant into the preoperative area. Please plan accordingly.
How long do you expect pain relief:
The trial duration is typically 4 days. After this time, the likelihood of scar tissue formation around the lead increases and the longer a lead is place, the risk of infection increases as well. However, if more time is needed to determine whether or not you have gained significant pain relief from this procedure, the time of the trial can be extended for an additional day or two. On the other hand, if after several days you know that this therapy is right for you, feel free to come in sooner to have the lead removed. At that time, we will schedule you for the permanent implant.