Pain is something that can quickly take over our lives. Pain can lead us to be more emotional and less empathetic with family and friends. It can hinder our ability to do things that make us feel better, such as exercise. It can take away our earning potential if we are unable to work because of the pain. In other words, pain can upend what you do and who you are.
And chronic pain like back or leg pain can be particularly overwhelming. It’s different than pain in an extremity like a finger or toe; leg or back pain starts in one spot and can radiate elsewhere and be unrelenting.
Many people start with traditional medicine such as pills or doctor visits, but those may have limited impact. They may also try natural healing, but again—the person may determine how effective those are. One treatment that works for many is spinal cord stimulation; this graphic explains what it is and how it might help.
What Is Spinal Cord Stimulation?
Spinal cord stimulation is a safe and relatively effective treatment option for certain individuals suffering from chronic back or leg pain. Roughly 80 percent of individuals who undergo SCS experience some form of relief, whether it be in the form of decreased pain, a reduction in the need for opioids or better sleep quality.
Our friends at PainInjuryRelief.com recently reached out to us with an infographic about spinal cord stimulation and asked if we’d be interested in sharing it with our readers. We are always happy to discuss new technologies and potential treatment options, so we’ve included it below. Check it out if you believe spinal cord stimulation may be something that you could benefit from.
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.
Increased Effectiveness
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.
Using electrical stimulation for the control of pain with an implanted device onto the spinal cord and in the epidural space was done for the first time in 1971. This began after the publishing of Melzack and Wall’s renown work on the “gate control theory” of pain. The theory proposed that nerves carrying painful peripheral stimuli travel into the dorsal horn of the spinal cord. Further, the “gate” may be manipulated or closed by other electrical impulses to the area. Since the initial device in 1971, technology and understanding of neuromodulation has greatly changed, and there are new developments coming to the field.
Spinal cord stimulation (SCS) is an advanced form of pain management. It is an implantable system that uses electrical signals to the spine to modulate pain signals traveling through the spine. The exact mechanism is unknown, but somehow the signal generated by the stimulator modifies pain signals such that one does not perceive their normal pain quality. In the simplest terms, it is a pacemaker for the spine, pacing out pain signals. Since it is an implantable device, versus a simple form of treatment like physical therapy or medication, it is not considered a first line of treatment, but something to consider if other treatments have failed. For pain management professionals, it is a treatment that should be considered before less successful treatments like multilevel spine decompressions or fusions. The cost effectiveness of this treatment is far superior to most lumbar surgeries and is typically more successful in controlling pain.
Spinal cord stimulation is used for a variety of painful conditions. In the United States, the most common use is for pain that continues after back surgery. It is also used for neuropathic (nerve damage) type pain in the extremities, complex regional pain syndrome, and extremity pain that is unlikely to be managed with back surgery. In Europe, it is also often used for ischemic vascular pain in the legs and also for angina. Occasionally it is used for peripheral nerve pain, especially for migraines caused by occipital nerve irritation.
Advantages of Spinal Cord Stimulation
The advantage of SCS is that it often can control pain that no other treatment has been able to impact. When performed by an experienced interventional pain physician, the pain relief success rate should be above 60% with a complication rate less than 5%. Problems that may occur range from stimulator lead movement, damage from the needle used to insert the electrodes and infections. That said, complications are rare. The newer units have long lasting batteries, and one company makes units that are MRI compatible. Further, before any implant, a trial is done to see if the technology is helpful and to ensure it does not change the anatomy in the body.
As the technology has improved, there have been some new techniques discovered on spinal cord stimulation. The first technique is high frequency and high density stimulation. The unit is programmed at a very high rate, and the patient does not actually feel the stimulation to the spine. The electrical impulses block the pain signals at the spinal level and there may be some indication that it may also begin changing the central brain perception of pain signals. Several different brands of stimulators can perform this type of function; whether one brand is better than another is not clear.
The second new development is a very specific burst pattern of stimulation. This pattern is thought to mimic the transmission of certain pain signals and may be more effective in some individuals in blocking pain with less actual sensation of the electrical signals from the stimulator unit. Again, it is thought to also change the brain’s ability to perceive excessive pain signals in chronic pain patients, resetting the brain to a more normal pain sensitivity. The last new technique is for a special electrode that allows for specific nerve root ganglion positioning of the electrode to block an isolated nerve pain generator.
Spinal cord stimulation is an excellent technology to block pain signals. Our knowledge and ability to use these techniques to help diminish pain is expanding rapidly. Government and insurance approval has slowed some of the new technology and proven techniques, but hopefully these will be approved in the future to treat pain. The future for these technologies is bright and these provide a good option when simpler methods do not work.
Treatment of chronic pain is often complicated and requires multiple strategies to solve the problem. 