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Spinal-cord-stimulation

Spinal-cord-stimulation (1)

02 Nov

Everyone’s pain is different, and the reality is that not everyone’s pain will respond as well to conservative treatment methods. Even patients who undergo more drastic treatments, like invasive surgeries, aren’t guaranteed pain relief. Experiencing this “refractory” pain – or pain that persists despite treatment, with no improvement in daily functioning – can feel hopeless, with few avenues for relief. But for some conditions, the answer may lie in a minimally invasive, reversible treatment called spinal cord stimulation.

How Does SCS Work?

Spinal cord stimulation (SCS), also known as neuromodulation, has been in use since the late 1960s, when it was used to treat patients with cancer pain.[1] The process is simple: Small electrical impulses delivered into the spinal cord interfere with the transmission of pain signals, which travel along the spinal cord to the brain. While it’s believed that the electrical impulses prevent the brain from receiving the pain signals, some of the specifics regarding how SCS relieves pain are still relatively unknown.[1]

SCS replaces the feeling of pain with a more pleasant tingling sensation (called paresthesia). Via an external programmer, patients are able to turn the system on or off and change the level of stimulation. The degree of patient and automatic control varies with the type of system implanted, with some systems even self-regulating based on the patient’s position.

SCS is most commonly utilized for conditions like failed back surgery syndrome and complex regional pain syndrome (CRPS), and has been proven successful for chronic back pain, neck pain, and ischemic and coronary artery disease. [2][3] Different providers have specific preferences and rationales for SCS selection, which may vary by patient, type of pain and provider experience.

Also, before implantation, Advanced Pain Management requires a behavioral health consolation with a licensed psychologist to determine the patient’s treatment goals and ensure that they are in the best possible position to achieve success with the treatment.

Implantation

One important component of SCS is that patients can try the device before deciding whether or not it’s right for them. The trial period lasts approximately one week, during which time patients assess how well the nerostimulator relieves their pain during normal, everyday activities.

For this trial, performed with local anesthetic, wire leads are inserted into the epidural space (the area around the spinal cord) and the patient gives feedback to determine the location that will provide optimal pain relief. The leads are then connected to an external stimulator.

If the patient and the physician deem the trial successful, which is often defined as a 50 percent or greater reduction in pain,[1] then a permanent device will be implanted. During this outpatient procedure, permanent leads are inserted into the epidural space and a small generator, to which the leads will be connected, is implanted beneath the skin, usually in the butt or abdomen.[2] Patients will then be able to program the device to meet their specific pain needs.

Timing and Side Effects

The timing of implantation can affect a patient’s outcome. The amount of time between when a patient’s pain starts and when the device is implanted is inversely related to the percentage of pain relief, meaning the earlier that treatment is commenced, the better the results. The Neuromodulation Appropriateness Consensus Committee, convened by the International Neuromodulation Society, recommends considering the device after conservative treatments have failed, but before long-term opioid use or reoperation.[3]

Just like with any treatment, though, there are possible side effects. Fortunately, the majority of complications are minor and easily reversible. The most common issue is hardware-related. For instance, a lead may shift out of position, become disconnected or break. Other minor problems can include infection and pain at the implant site, which rarely affect a patient’s long-term health. [1][3]

The Future of SCS

This treatment is evolving, and exciting new models of SCS devices are becoming available, which could mean better pain control for many, including some who have already tried and failed SCS trials.[4] For instance, one new device offers pain relief without the tingling sensation of paresthesia, while another allows the user to switch between paresthesia and non-paresthesia pain relief. Yet another may provide relief for those with lower extremity pain, which has been difficult to treat with current devices.

For more information regarding spinal cord stimulation, or to find out if it may be right for you, call (888) 901-PAIN (7246) or click below to schedule a consultation. You can also read a story from real-life APM patient Maria, whose neurostimulator helped her overcome the pain of CRPS.

Get moving. Call (888) 901-PAIN (7246) or click to schedule a consultation now.

[1] Jeon, Young Hoon. "Spinal Cord Stimulation in Pain Management: A Review." The Korean Journal of Pain 25, no. 3 (July 2012): 143-50.

[2] “ViewMedica Patient Engagement Videos.” Swarm Interactive. 2015. Accessed April 8, 2016. http://www.viewmedica.com/.

[3] Deer, Timothy R., et. al. "The Appropriate Use of Neurostimulation: Avoidance and Treatment of Complications of Neurostimulation Therapies for the Treatment of Chronic Pain." Neuromodulation: Technology at the Neural Interface 17, no. 6 (August 2014): 571-598.

[4] "Advances in Neuromodulation." PainPathways Magazine. December 01, 2015. Accessed April 11, 2016. http://www.painpathways.org/advances-in-neuromodulation/.

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