The North American Neuromodulation Society defines neuromodulation as the direct stimulation of nerves by electrical stimulation. I want to stress that this is NOT a TENS unit! This is a surgically implanted device used to “interrupt” pain signals to the brain. This stimulation does not cause muscle contraction or interrupt sensory input such as touch. The patient will have full sensation and function without the pain when the unit is on. For instance, if a patient stubs their toe they will still feel the acute pain. However, if the patient suffers from arthritis or neuropathy in the lower limbs, the spinal cord stimulation will improve this pain.
This therapy is appropriate for a broad range of individuals that suffer from back pain, neck pain, complex regional pain syndrome, and neuropathy to name a few. It is an option for patients that have failed to receive relief from previous surgery, if the patient is not a good candidate to undergo a larger surgery, or if there is no other clear surgical option. The spinal cord stimulation (SCS) device is reversible and adjustable. Generally the SCS device is placed directly in the spinal canal; however there is also now a version called dorsal root ganglion stimulation where the stimulation electrodes are placed on one specific nerve that may have been damaged and is now causing chronic pain.
Before the SCS device is implanted, patients undergo a trial period of 4-5 days where a pain management physician or anesthesiologist will implant a smaller electrode version with a needle into the thoracic spine under x-ray guidance, and an external device (generator) is worn for a short period. This trial allows patients to try the technology before undergoing any surgery to determine if it is the correct treatment for them. If this trial goes well, then it is possible to move forward with the permanent placement of the SCS device. We use the word permanent however this device is removable with a small surgery.
Patients that undergo SCS treatment experience decreased pain and improved mobility. This leads to an improved quality of life. This technology is not one size fits all and is programmed specifically for each patient’s pain. Patient’s pain can often change over the years and the SCS can be adjusted for this change in pain or symptoms. When the SCS is turned on, some patients may experience a slight buzzing or tingling sensation called paresthesia. However, there are now several high frequency options that do not cause any paresthesias but only a lack of pain when on. Inability to undergo MRI if needed was another disadvantage of SCS treatment, however this is also no longer a concern as there are new MRI safe versions of SCS available.
The SCS surgery itself is approximately 45-60 minutes performed under general anesthesia. There are 2 incisions made: one vertical incision that is mid-thoracic (ribcage area) and one horizontal incision at the right or left flank. It takes several weeks to recover from this surgery. Bending, lifting, or twisting should be limited while the incisions are healing and soaking bath tubs or hot tubs should be avoided to reduce the risk of infection.
The SCS generator needs to be replaced approximately every 7-9 years depending on brand and usage. We perform this procedure frequently since patients do not want to discontinue the therapy. This therapy often allows patients to greatly decrease their narcotic pain medication use to eventually be narcotic pain medication free. There have been many advances in SCS over the last 10 years and this technology overall has been used for several decades.
Many of our patients go through with the trial and cannot wait to get the unit placed with surgery! Recently one of our elderly patients (over 90 years old) that underwent this surgery came in for her one month post-operative appointment and gave me a hug because she was now able to stand without pain for long enough to cook herself dinner. This unit gave her back her independence and ability to care for herself without pain.
There are several companies in the United States that offer this technology; Boston Scientific, Nevro, St. Jude’s, and Medtronic. Please see the end of this blog for their website information. Please contact our office if you have any questions about SCS therapy.
Shaylan Zanecki PA-C
Director of Patient Safety & Clinical Research