Spinal cord stimulation for chronic pain

Treatment Overview

Spinal cord stimulation (SCS) is a procedure that uses an electrical current to treat chronic pain. A small pulse generator, implanted in the back, sends electrical pulses to the spinal cord. These pulses interfere with the nerve impulses that make you feel pain.

Implanting the stimulator is typically done using a local anesthetic and a sedative. Your doctor usually will first insert a trial stimulator through the skin (percutaneously) to give the treatment a trial run. (A percutaneous stimulator tends to move from its original location, so it is considered temporary.) If the trial is successful, your doctor can implant a more permanent stimulator. The stimulator itself is implanted under the skin of the belly (abdomen), and the small coated wires (leads) are inserted under the skin to the point where they are inserted into the spinal canal. This placement in the abdomen is a more stable, effective location. Most stimulator batteries must be replaced every 2 to 5 years.

After this outpatient procedure is complete, you and your doctor determine the best pulse strength. You are then told how to use the stimulator at home. A typical schedule for spinal cord stimulation is to use it for 1 or 2 hours, 3 or 4 times a day.

When in use, the spinal cord stimulator creates a tingling feeling, rather than the pain you have felt in the past.

What To Expect After Treatment

You will have a small incision that you should keep clean and dry until it heals.

Why It Is Done

This treatment may be done for people with severe, chronic pain who have:

• Had a failed spinal surgery.
• Severe nerve-related pain or numbness.
• Chronic pain syndromes, such as reflex sympathetic dystrophy.

Spinal cord stimulation is typically considered investigational for various other conditions, including multiple sclerosis, paraplegia, and intractable angina.

How Well It Works

Some researchers have reported that more than half of people receiving spinal cord stimulation for failed-back surgery syndrome, peripheral neuropathy, or phantom limb pain have pain reduction or relief.¹ Spinal cord stimulation seems to work better for people who have reflex sympathetic dystrophy or postherpetic neuralgia.

But there is still not strong proof that spinal cord stimulation works. Better research is needed. Treatment success varies widely and is influenced by the cause of pain. Also, if there has been a previous back surgery, treatment success is affected by the amount of time that has passed since the first surgery on the affected area. The more time that has passed since a first surgery, the less likely spinal cord stimulation is to overcome the pain signals that have developed over time.

One long-term study suggests that conditions that are most likely to have long-term benefit from spinal cord stimulation are failed back syndrome (pain that spreads or that continues after surgery), reflex sympathetic dystrophy, multiple sclerosis, peripheral arterial disease, and peripheral neuropathy.²

Initial pain relief is often followed by a gradual decline in effectiveness, apparently caused by the body's increasing tolerance to the treatment.

Risks

Possible risks related to spinal cord stimulation include:

• Scar tissue (fibrosis) developing around the electrode.
• Pain gradually moving beyond the reach of the nerve stimulator.
• Breakage of an electrode or hardware failure.
• Infection.
• Leakage of spinal fluid.
• Headache.
• Bladder problems.
• Getting used to the stimulation, making it less effective.

What To Think About

Spinal cord stimulation may be recommended for a small subset of people suffering from certain types of chronic pain such as pain from a nerve root injury.

Most spinal cord stimulator batteries must be replaced every 2 to 5 years.

Complete the special treatment information form (PDF) (What is a PDF document?) to help you understand this treatment.

Author:	Monica Rhodes	Last Updated: January 20, 2009
Medical Review:	Anne C. Poinier, MD - Internal Medicine Nancy Greenwald, MD - Physical Medicine and Rehabilitation
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