Pain Technologies: Spinal Cord Stimulation
Long before Benjamin Franklin in 1775 “discovered” electricity with his famous key on a kite string experiment, medical scientists have been using electricity to treat pain and other disorders of the human body. Ancient Egyptians apparently used electricity generated by the Nile catfish in the treatment of headaches, gout and nerve pain. Physicians experimented with electro-acupuncture and various other electrical therapies throughout the 18th and 19th centuries, culminating in the TENS (Transcutaneous Electrical Nerve Stimulation) unit, which is the most widely used form of electrical therapy today.
Eventually cardiac pacemakers were developed to control heart rate and implantable defibrillators were being used to prevent cardiac arrest in some heart patients. A spin-off of this technology resulted in the development of spinal cord stimulators, and the first system was implanted in 1967 for the pain of lung cancer. Many improvements have been made in the hardware and computer programming of modern spinal cord stimulators, which today are being used routinely as an advanced way to alleviate pain from sciatica, failed back surgery, peripheral vascular disease, reflex sympathetic dystrophy (RSD or CRPS), interstitial cystitis, and other nerve related pains.
Your physician may have recommended this treatment to you or a family member with a difficult pain problem that has proved unresponsive to more conservative therapies such as medications. Although medical science has not been able to determine exactly how spinal cord stimulation works, it has been determined that stimulation is safe for long-term use.
In our bodies, the spinal cord is responsible for transmitting pain signals to the brain. By changing the natural electrical properties within the spinal cord we are able to decrease pain by decreasing the pain signals that travel through the spinal cord up to the brain where they are perceived. So although the pain still exists, it is not being “felt” as much because the brain is not receiving the pain message.
If you have a pain problem in one of the above-mentioned categories, we can do a trial to see if you respond to spinal cord stimulation. This is a minor procedure done with sedation in the operating room; patients usually experience modest discomfort during the local anesthetic only.
With the use of fluoroscopy (low-dose X-ray) a needle is placed under local anesthetic into the epidural space around the spinal cord in your back. This is similar to an epidural injection, except instead of injecting medication we deliver thin wires with several electrical contacts at the tips of the wires. These wires (stimulator leads) are precisely located on top of the spinal cord and programmed by computer to change the electrical impulses traveling up the spine. The spinal cord stimulator works in the areas you’ve reported as painful; the new sensation in these areas is frequently described as massaging and much less painful.
An incision is usually made in the back over the area where the stimulator leads are inserted. Just under the skin, an anchoring stitch holds the leads in place. During the trial period a temporary connector wire will exit the skin in the low back, which is connected to an external power source for the stimulator leads. This system is easily carried on a waist belt for the 7-day trial. You will also have a handheld remote allowing you to adjust stimulation patterns and strength.
During the trial period, patients are on oral antibiotic medications, and require frequent visits to Riverside Spine to monitor for pain control, infection, and success with therapy. We can make many changes to the electrical stimulation pattern and location, giving you several options with therapy and a nearly unlimited number of programs to cover various areas of your pain in different ways.
At the end of a successful trial period, we’ll discuss options for implanting a small battery to power the leads, eliminating the use of the external connectors and battery system.
Reasonable expectations of therapy are that you experience about half of your original pain, perhaps with more activity tolerance and less oral pain medications. About ¾ of patients experience such relief. If your doctor has recommended this to you, it is because we feel you are a properly motivated patient with a pain problem that may lend itself to neurostimulation.
More information, patient testimonials and images are available by visiting http://www.controlyourpain.com for the Advanced Bionics spinal cord stimulator system, http://www.tamethepain.com for the Medtronic system, or http://www.poweroveryourpain.comfor St. Jude Medical (ANS) spinal cord stimulator system.
Note: This information is intended to be an educational supplement to a complete discussion with your physician about this therapy; it not intended to replace a full display of the risks and procedures associated with this therapy, which will be part of an ongoing educational process you will experience as you progress through the various stages of therapy.