Treatment of chronic pain is often complicated and requires multiple strategies to solve the problem. Spinal cord stimulation is an advanced strategy in the United States, but in other parts of the world, it is often employed even prior to spine surgery. Over the last several years, there have been several new developments in the field, but whether they will help more than a few it remains to be seen.
Spinal Cord Stimulation For Pain
The science behind spinal cord stimulation goes back to 1984 when Medtronic designed the first unit. The original technology was adapted from heart pacemakers, and this concept remains about the same, except that we are pacing the nervous system instead of the heart. Over the last 30 years, research has improved in several areas including shrinking of electronic circuits as well as improved battery technology.
Besides these obvious areas, medical science has greatly advanced in understanding different components of the nervous system and diseases that may be contributing to pain. As technology has improved, the ability to electrically stimulate the nervous system has also changed. We know how to better find and block or modulate the abnormal signals causing pain. We can use multiple programs to change the pain signals and often find a variety of different things that all dampen pain, making it more manageable. Now that the batteries for these units are remotely rechargeable through the skin, the units are no longer limited by how long the battery would last.
Basic science has also contributed to increased effectiveness of spinal cord stimulation. We have a better understanding about how pain signals travel from the periphery of the body to the brain through the spinal cord. We now can direct signals to very specific regions of the cord to be more effective in controlling pain. For some very isolated pain situations, we can stimulate a specific nerve in the periphery of the body (known as peripheral nerve stimulation), or just as the nerve enters the spine (dorsal root ganglion stimulation). For some people, stimulating the spine at the thoracic T9 level at a high rate can not be felt, but it is effective to block pain signals. The last new pattern is known as burst stimulation, and that is using a special pattern of high frequency pulses to the spinal cord to block transmission of pain signals.
The new forms of spinal cord stimulation use a variety of electrical techniques to modify the ability of painful electrical signals to travel from the periphery to the brain. At this time, pain specialists cannot tell whether a certain type of electrical stimulation will be helpful unless a reversible trial is performed. If conservative treatment has failed to control pain, an interventional pain expert who has experience with spinal cord stimulation may be able to help determine whether this type of therapy is a reasonable option.
With the new types of stimulation available, if you are a candidate for implantable management options, this type of intervention is often an extremely successful treatment. In the right person, the success for pain control is about 70 percent, and failure is due to a variety of factors but especially due to patients disliking the electrical stimulation sensation. As technology improves, hopefully this will be used earlier in the treatment of pain.
Thomas Cohn, MD
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