Spinal Cord Stimulation

If you are suffering from chronic pain, you know just how terrible it can feel to not only perform the simplest of tasks or movements, but to also just live in general. Chronic pain can affect any part of the body, and can be a constant pain or can come and go in both intensity and duration. If therapeutic methods and medications have failed to provide any sort of complete or long-term relief, spinal cord stimulation might be the solution. The California Pan Care team in the Escondido, El Centro, La Mesa, San Diego, Chula Vista areas is committed to helping their family of patients experience pain-free days and years, finally saying goodbye to chronic pain. 

What is Spinal Cord Stimulation? 

Spinal cord stimulator therapy is an ever-increasingly popular way for providers to help patients who are experiencing chronic pain and who have yet to find relief. Dubbed the “pacemaker for pain,” spinal cord stimulators essentially replace the feeling of pain with a light tingling sensation. 

The device is implanted into the epidural space in the spinal cord, as close as possible to the area where pain is felt. The device produces a low electrical current that interrupts the pain sensations from traveling to the brain, so instead of feeling pain the patient feels a tingling feeling. 

One of the amazing benefits of this device is that the patient can control the level of the tingling sensation, as well as being able to turn the device on and off, targeting only when the pain is felt so it can be combated. Another benefit is that it helps patients manage their chronic pain without having to rely on prescription-strength medication (and possible overuse) and invasive surgical options. So overall it’s a great minimally-invasive option that provides predictable and reliable results. 

Most patients begin with a temporary device outside of the body to determine its effectiveness before opting to receive a permanent device. 

How Does Spinal Cord Stimulation Work?

To understand how a spinal cord stimulator works, it’s first helpful to understand about the nervous system and how pain is recognized. 

Pain is generally felt as a protective mechanism for the self. “Ouch, that hurts!” tells our hand to back away from fire, or to move our foot from the nail it’s accidentally pressing on. It can also be a helpful sign that alarms us to illnesses and diseases in the body. However, there are times when pain is not a protective measure. There are many conditions that cause chronic pain that just doesn’t ease, regardless of the effort made by the patient. Chronic pain not only has severe consequences to a person’s way of life and quality of life, but, if experienced for long enough, can actually cause changes to the person’s brain and nervous system, which work hand in hand. A person can begin to experience hyperalgesia, which is when pain is perceived as more severe than it actually is, or allodynia, which is when the nervous system sends pain signals for sensations that actually shouldn’t hurt at all. The nervous system might even send pain signals randomly and for no reason at all. This is what makes chronic pain so debilitating.

Pain, regardless of the location in the body, is felt by signals transmitted by nerves throughout the body to the brain. This is an electrochemical process so it can be influenced by electricity. While most people might think (and rightly so!) that electricity can cause pain, think electric shock therapy, electrical currents can also disrupt and reduce pain. Spinal cord stimulation (also known as neuromodulation) uses a mild electrical current to stimulate certain nerve fibers in your spinal cord, which essentially replace the nerve fibers that are sending pain signals and reduce the perception of pain. The belief is that the body can only perceive a certain amount of nerve stimulation coming from one part of the body, so it will perceive the tingling sensation if it is greater than the pain sensation. This method is incredibly useful for managing pain due to nerve damage or inflammation.

What Conditions Does Spinal Cord Stimulation Treat?

Overall, spinal cord stimulation is a safe, effective and drug-free way to finally provide relief for patients who are living with chronic pain and who haven’t been able to find relief from other therapy and treatment options. Spinal cord stimulation has proved to be effective in helping to alleviate pain associated with the following conditions: 

• Continued back pain after failed back surgery syndrome (FBSS)
• Degenerative disc disease
• Spinal stenosis
• Nerve root compression
• Sciatica or lumbar radiculitis
• Peripheral neuropathy
• Complex regional pain syndrome (CRPS)
• Central sensitization
• Diabetes-related neuropathy (nerve damage)
• Neuropathic pain

Spinal cord stimulation has been shown to both reduce the level of chronic pain and person feels, as well as reduce the amount of pain medication that a person is prescribed to take to manage the pain. 

How Effective is Spinal Cord Stimulation?

While research is still being conducted into the efficacy of spinal cord stimulation for treating all types of chronic pain, results are promising for the aforementioned causes of chronic pain conditions. Researchers first discovered the technique of using electrical impulses as an effective treatment for managing chronic pain in the 1960s, so new studies (or, rather, new findings) are always providing greater insight into the expanded possibilities of spinal cord stimulation. 

Currently, the evidence for spinal cord stimulation has shown great results for providing strong short-term relief and moderate long-term relief for chronic pain associated with failed back surgery syndrome and complex regional pain syndrome. This method has also been successful for patients for treating chronic pain due to spinal stenosis. 

A main key to spinal cord stimulation is when the patient begins the treatment. Studies show that 75% of patients who began treatment within two years of first experiencing chronic pain were able to find relief, but it dropped to only 15% if the leads were placed after the two year mark. 

Research continues to prove that spinal cord stimulation is an effective method for treating chronic pain from a host of conditions. While there are patients who did not find the treatment helpful, more often than not, it was effectively prescribed, implanted and used. 

Another benefit worth highlighting is that the initial trial period is performed with a temporary device. This means that if the patient does not experience pain relief from their chronic pain, there is no need to go further. But for those who did find their intended relief, they can have the permanent device implanted and look forward to a pain-free life. 

What Does Spinal Cord Stimulation Procedure Involve?

Typically, spinal cord stimulation isn’t a first-line procedure. Patients generally try physical therapy, pain medications and pain injections or nerve blocks first. If and when those methods don’t work as intended, your pain management specialist could discuss spinal cord stimulation. Before any treatment is given, they will first make sure you are healthy enough for surgery, as well as rule out any reasons why this surgery is the incorrect treatment or there might be reasons why this surgery isn’t the best option for managing your particular type of chronic pain. 

The spinal cord stimulation procedure is a two-hour process that is performed under local anesthetic or “twilight” sedation as an outpatient procedure. Your pain management specialist will first numb the area of the injection site, which should be the only time you feel pain. Once you are comfortable the specialist will use X-ray guidance (fluoroscopy) to place the trial spinal cord stimulator leads into the epidural space via a needle. Each lead is a soft, thin wire that has electrical leads on its tip. You can expect to wear the trial stimulator for five to seven days, wherein you’ll wear the generator (batter back) outside of the body. After the trial period, you will provide feedback as to whether you feel the procedure has been effective in managing your chronic pain. 

If the trial successfully relieves your chronic pain, your provider will then form a second surgery to implant a more permanent generator, which is done through another incision. The generator is about the size of a book of matches and is only slightly visible on the outside of the skin. 

After the procedure is complete, you will have a handheld remote that you can use to control the amount of stimulation you feel through the leads. So if you aren’t feeling any pain at the moment, you can turn the device off. Or, if you’re experiencing an intense amount of chronic pain, you can amp up the stimulation and experience total relief. 

Post-procedure recommendations include resting, keeping the injection site clean and dry, and using ice packs and/or pain medications (as prescribed) as needed. With any surgical procedure, there is the potential for experiencing side effects. These include: 

• Bleeding
• Scar tissue buildup
• Electrode failure
• Device malfunction
• Hardware migration
• Infection (bleeding, fever, swelling or pain)
• Gradual loss of pain relief
• Leads moving out of position

Due to the recent and continual advancements in neurostimulation devices, patients continue to benefit from not only more efficient pain relief but also a better device in general. Advancements include miniaturization of the device itself, greater coverage and coverage in areas that were previously unreachable, and reduced discomfort with the tingling sensation so that patients can experience pain relief without experiencing any other sensations. 

Additional Neurostimulation Options for Pain Management

Beyond spinal cord stimulators, there are now a few other options for treating chronic pain with electric processes. 

• TENS units (Transcutaneous Electrical Nerve Stimulation): this device uses patches placed on the skin to deliver stimulation, which affects the nerves in the area directly under the patch
• Peripheral nerve stimulators: this device is similar to a spinal cord stimulator in that it is implanted, but the main difference is that the device targets nerves outside of the spine, such as the shoulder or knee. There are even some devices that are directly implanted into the brain, which are used mostly for non-pain related conditions like epilepsy. 

The greatest advancement is that stimulators are effective for treating various types of nerve pain in a variety of locations, including locations due to referred pain. Additional and newer therapy options include: 

• Burst stimulation: for patients who find the tingling sensation unpleasant, burst stimulation offers the same pain relief but without the constant tingling sensation, also known as paresthesia. New studies have shown that five brief bursts, followed by a period of no bursts, each lasting one thousandth of a second, followed by one thousandth of a second with no stimulation, can provide relief from chronic pain. 
• High-frequency stimulation: stimulation produced at a high frequency, such as 10,000 cycles per second, has proven to provide a level of pain relief greater than most neurostimulation devices, but after a longer period of time since beginning the stimulation. This form of stimulation does not produce paresthesia. 
• Dorsal root ganglion stimulation (or DRG stimulation): while some neurostimulation devices target the nerve itself, there are options where the body regions that are feeling pain are not the same regions where the pain is being caused. There is some new research that involves placing leads along a bundle of nerves where they branch off from the spinal cord, called a dorsal root ganglion. Each bundle is responsible for handling nerves from a specific region of the body, so by stimulating each particular ganglion tiles a different stimulation result. 

Spinal cord stimulators are an effective neurostimulation device that has proven to provide patients who are experiencing chronic pain from a myriad of health and medical conditions with the relief they’re needing and wanting. If you feel that spinal cord stimulation can benefit you and improve your quality of life, please schedule an appointment today. The California Pain Consultants team of pain management specialists in the Escondido, El Centro, La Mesa, San Diego, Chula Vista areas is available to learn about your specific feelings on chronic pain and recommend the best treatment options to help you achieve your lifestyle goals.