What is spinal cord stimulation?
Spinal cord stimulation is a type of neuromodulation, which affects how nerves send their signals. The technology has been around since 1980 and is continually evolving and improving.
In spinal cord stimulation, two electrodes are placed on the spinal cord, underneath the bone but outside of the protective dural sac. The electrodes are connected to a battery implanted in your body. The electrodes send electrical signals back and forth between each other and change the way nerves send and receive signals to help treat the pain that you’re feeling in a specific area of your body.
The battery also contains a computer “brain” that can change the type of signals it gives, and it can be reprogrammed in many ways. The electrodes themselves are positioned very specifically over part of the spinal cord to target different areas of pain in the body.
What types of pain does spinal cord stimulation treat?
Spinal cord stimulation treats nerve pain, or neuropathic pain. Neuropathic pain can come from many different causes, including vitamin deficiencies, environmental exposures, HIV, alcohol, diabetes, chemo, surgery, or how your body and nerves are currently working.
Would spinal cord stimulation work for me?
- Do you have a diagnosis of neuropathy? Are you experiencing the painful pins and needles burning or aching sensation in your toes, feet, ankles, or legs?
- Has your doctor been able to find a cause for your pain? Have other potential causes been ruled out? Some neuropathy is idiopathic, or from no known cause. Other times, the neuropathy is from a known experience or disease, such as chemo or diabetes. Still other times, the neuropathy could be from an irritation of a nerve in the back, for example.
- Are your symptoms painful enough to keep you from doing things you want or need to do?
- Have you tried medications? The first treatment to try with neuropathy is neuropathic medications, which are lower risk than the surgical procedure of a spinal cord stimulator device.
What is the evidence?
Randomized control trials started around 2014, with follow-up studies since then. For patients who undergo a trial of a spinal cord stimulator, about 80% have very good pain relief. Patients who have good pain relief are likely to have the system implanted. Of the patients with permanent systems, 70% of the patients have at least 50% or greater pain relief. About 55-60% of patients who have the permanent system are still having meaningful pain relief 8 to 10 years later. All these numbers are compared with the relief patients receive from medication. Patients who opt for a spinal cord stimulator generally are not getting much relief from medications.
Not every patient receives pain relief from a spinal cord stimulator. A trial is done before it is implanted to help see if it would be helpful.
What is the process?
- If you meet the criteria discussed above, make an appointment with an interventional pain physician.
- Talk with the doctor about your symptoms, medications you’ve tried, your medical history, and any other conditions you may have. The doctor will answer your questions about the stimulator, the process, risks, etc. and can give you information on the spinal cord stimulator manufacturers.
- You can talk with the representatives from the manufacturers to get questions answered.
- You and your doctor agree that you’re a candidate for the spinal cord stimulator.
- You get an MRI of the thoracic spine (mid-spine) to make sure there is room for the system to be in place safely.
- Meet with a pain psychologist to discuss your expectations of this therapy, what you feel like it will help you with, and make sure everyone is on the same page in terms of expected pain relief.
- Get the spinal cord stimulator in a trial in an in-office procedure. Test leads are placed on your spinal cord through the skin in a procedure similar to an epidural injection. A sterile bandage is placed where the leads come out of your skin, and the battery is taped to your side.
- You have the system for about 7 days. You speak regularly with the representative from the device manufacturer and see how the system works for you, trying out different settings with the stimulator.
- After the trial, you go back to the office to have the leads removed. Your back heals up easily from the small holes. If the trial was successful, you talk with your doctor about implantation of the permanent system.
Frequently Asked Questions
Is it covered by insurance?
Yes, spinal cord stimulation for neuropathy pain is generally covered by insurance. For details on your specific plan, call the number on the back of your insurance card.
Can the spinal cord stimulator be used if you have rods in your spine?
Potentially, depending on where the rods are placed. Your doctor would have to see in your specific case.
How do rechargeable stimulators work?
The device companies make both rechargeable and non-rechargeable battery systems. Most systems, of either type, will last 9 to 10 years. The exact amount of time it will last depends on the type of programming and the energy needed to achieve the desired pain relief. Recharging is typically done with an induction device that sits on top of the battery, on your skin, held in place with a magnet. You can sit down for 30-60 minutes and recharge the battery. Often the device has a remote that shows you the battery level as well.
How soon after a trial is the permanent stimulator implanted?
There’s not an extended period of time. On average it’s a month or less.