Chronic pain is pain that persists for long periods of time. It may be exhausting, debilitating, and can greatly impact quality of life.
What is spinal cord stimulation?
Spinal cord stimulation treats neuropathic or nerve pain. I like to describe spinal cord stimulation as electrical medicine: we use a safe amount of electricity to stimulate parts of the spine and nerves to help treat pain.
In the spine there are certain areas where painful information is sent to the central nervous system. By placing some electrical leads over these areas and sending a safe amount of electricity, we can change how the pain signals are interpreted by the body. This change is called neuromodulation.
What is a spinal cord stimulator system?
There are small leads, or little wires, that are placed through a needle into the back part of the spine between the bony part and the spinal cord.
Once the leads are in, they are connected to a battery unit, which has the hardware and software built in. The battery unit connects to an external device which allows customizations and programming. The external unit uses wireless technology such as Bluetooth and allows us to program specific types of treatments that are tailored to the type of pain you have.
When we place the leads, we put them in the position to best help the type of pain the patient has. We can tailor it if it’s more to one side of the body, or leg pain versus back pain. The ultimate goal is to make a tailored solution for the patient.
Conditions for spinal cord stimulation
There are several major types of pain conditions that we use spinal cord stimulation to treat.
Chronic spinal pain syndrome
This condition is when someone has persistent back and leg pain after prior spine surgery. It was previously known as post-laminectomy syndrome or failed back syndrome.
Chronic radiculopathy
Radiculopathy is an irritation of the nerve root that causes chronic pain.
Painful diabetic neuropathy
When the blood sugar is elevated in someone with diabetes, it may cause irritation of the nerves, especially in the legs.
Neuropathy from chemotherapy or cancer
Some types of cancer or cancer treatments may cause neuropathy in some patients.
Post-surgical pain
Some people may have persistent pain after a total hip or total knee replacement, chronic abdominal pain after abdominal surgeries, or pain after amputations.
Complex regional pain syndrome
This diagnosis is made by a physician based on certain signs, symptoms and clinical findings.
Identifying the right patient
There’s not a one-size-fits-all answer. I have a conversation with the patient, look at their prior imaging or order further imaging, and look at the medications and treatments that they have tried. Since spinal cord stimulation treats chronic pain, patients have tried many different treatments and they’re still having pain that is severely impacting their day-to-day activity, their quality of life, and their function.
While the diagnoses listed above are common diagnoses for patients who qualify for spinal cord stimulation, the system is not the right fit for all patients with those conditions.
When we’re considering a patient for spinal cord stimulation, we set expectations about their goals. How is the pain limiting them? Where is their pain? Most insurance companies also require a psychological evaluation, which I see great value in. Chronic pain can be exhausting and there may be depression and anxiety that come along with it. We want to make sure we’re treating the whole person.
The spinal cord stimulation trial
One way spinal cord stimulation is unique is that there is a trial period: it’s one of the very few things in medicine where we can try out the treatment before it is permanent.
During the trial, I place temporary leads into the back of the spine and connect them to a temporary battery unit. The battery unit is attached to your skin with a pouch and special tape. You then use the spinal cord stimulator for a few days, typically less than a week, to understand how much the treatment can help you. During that time you’ll work together with a representative from the device manufacturer to make adjustments to make the stimulator system work better.
The goal is to understand how much the spinal cord stimulation helps your pain. We don’t want to do something just to do something.
After the trial, we remove the temporary leads and have a conversation about how much the trial helped. We evaluate improvements in pain as well as any improvements in mood, sleep, or any other limitations. We then have a shared decision to see if the device should be implanted permanently.
Implanting the device
During the implantation of the permanent device, the leads are run under the skin and the battery pack is placed under the skin. It’s an outpatient procedure where people go home the same day. Some people may receive sedation or anesthesia during the procedure to help keep them comfortable.
After implantation
After the device is implanted, we will look at your function and see if we can reduce the use of other medications you may be on, to maximize the use of the device and reduce the opportunity for medication side effects.
Frequently asked questions
Will a spinal cord stimulation system limit imaging such as MRIs in the future?
There are some limitations, but you can still have CT scans and MRIs. The exact details depend on the specifics of the system.
Can I do regular activities with a spinal cord stimulation system? Can I exercise?
During the trial period there will be some temporary limits on your activity, because the leads are in place temporarily and you don’t want them pulling out. There will also be some temporary restrictions after you first get the system implanted, until everything heals. After that, you can resume your regular activities. The goal of the system is to get you moving and active again. If you have specific questions, talk to your doctor.
Will I beep at the airport security desk?
Yes, you may beep. Everyone receives a card that says that you have the device in place and I encourage my patients to bring that with them if they’re traveling.
Is the spinal cord stimulation system permanent?
The system is designed to be permanent but can be taken out if it is no longer providing relief or is no longer needed.
Does Medicare or other insurance cover spinal cord stimulation?
Yes, Medicare and private insurers cover spinal cord stimulation for the appropriate diagnoses. Some insurance plans may require a psychological evaluation before receiving the treatment, which I think is a valuable piece, but it is generally covered as well.
How is spinal cord stimulation similar to or different from a TENS unit?
A TENS unit uses small sticky pads placed on the skin to send electrical impulses. It’s done through the skin and involves your muscles. Spinal cord stimulation is done under the skin, inside your body, directly to your nerves. A TENS unit may help with muscle pain, while spinal cord stimulation may help with neuropathy.