Spinal Cord Stimulator

Spinal cord stimulation (SCS) is a procedure that uses an electrical current to treat chronic pain. A small pulse generator, implanted in the back, sends electrical pulses to the spinal cord. These pulses interfere with the nerve impulses that make you feel pain. They prevent pain signals from being received by the brain.

Pain felt anywhere on the body can be problematic. Whether it’s in the muscles, joints, nerves or organs, pain can keep a person from experiencing an ideal quality of life, even if it’s just for a few days or weeks. However, when a person has to live with pain that lasts months or years, it becomes hugely debilitating, especially if treatment methods fail to provide long-lasting and much needed relief. This is where spinal cord stimulators have proven helpful. Used for patients who haven’t been able to find pain relief from other conservative methods, spinal cord stimulation uses electrical current to stimulate the spinal cord with a goal to provide long-lasting relief for several different pain conditions. The Nevada Advanced Pain Specialists in the Reno, Sparks and Carson City areas are highly trained in this treatment method and have been able to provide their patients with the relief they’ve been unable to find with other treatment methods. 

What is a Spinal Cord Stimulator?

A spinal cord stimulator is a device, dubbed the “pacemaker for pain” that uses an electrical current to prevent pain signals from being received by the brain. It has been a proven treatment method for treating chronic low back pain, chronic neck pain, chronic thoracic pain, chronic sciatica, pain after low back or neck surgery, complex regional pain syndrome, peripheral neuropathy, and more. 

The stimulator itself is a small device that is implanted under the skin. This device emits a mild electrical current that essentially replaces pain sensations with a buzzing or tingling sensation. Patients who have previously suffered with chronic pain have found immediate and profound pain relief. An added benefit is that the patient is able to control the level of stimulation, so can increase it or decrease it as pain is felt, allowing the patient to utilize treatment only when it’s needed.  

How Does a Spinal Cord Stimulator Work?

To understand how stimulation works to relieve pain is to first understand how pain is felt. Generally speaking, pain is your body’s way of helping itself. If you’re too close to fire, or are stepping on something sharp, your body alarms your brain, effectively telling you to get out of that environment or stop stepping on the sharp object. It can also let us know if we are suffering from a medical condition or an illness. However, there are certain instances where pain is due to a condition. If that condition isn’t treated, or isn’t properly treated, then the pain can become chronic, meaning that it lasts for months or longer. On top of having to deal with chronic pain as a result of one condition, chronic pain can also change how our brain perceives pain. This change could lead to pain feeling more severe (hyperalgesia), cause our nerves to send pain signals when pain isn’t felt (allodynia), as well as the nervous system ceaselessly sending pain signals without reason.  

What makes a spinal cord stimulator so successful is that it targets the nerves that are sending the incorrect and constant pain signals to the brain. Our nervous system is a network of nerves throughout the body, so while some other treatments are able to target only one part of the body, a spinal cord stimulator is able to effectively treat any area, or multiple areas, at the same time. 

Spinal cord stimulation is a neuromodulation or neurostimulation technique. The belief is that since our perception of pain is an electrochemical process, introducing electrical impulses helps to overload the brain’s perception of pain from that one area. The brain then stops recognizing those specific pain sensations, thereby reducing the amount of pain felt. It might seem counterintuitive to use electricity to reduce pain, but it has proven helpful since the 1960s, and most especially for patients who were experiencing pain due to nerve damage or inflammation. 

What Conditions Does a Spinal Cord Stimulator Treat?

Spinal cord stimulation has been proven incredibly helpful for patients who are suffering from chronic pain and who have yet to find relief. The most common conditions include: 

• Failed back surgery syndrome (FBSS)
• Degenerative disc disease
• Complex regional pain syndrome (CRPS)
• Diabetes-related neuropathy
• Neuropathic pain
• Spinal stenosis
• Sciatica or lumbar radiculitis
• Peripheral neuropathy
• Nerve root compression
• Central sensitization
• Postherpetic neuralgia
• Chronic back pain

In addition to providing patients with incredible pain relief, patients are also able to reduce their need for taking pain medications, as well as more comfortably enjoy continued healing methods such as physical therapy or conservative therapies. 

What Does a Spinal Cord Stimulator Procedure Involve?

If you’re considering a spinal cord stimulator, this means that you’ve most likely unsuccessfully utilized several other treatment methods. Your pain management specialist and medical team, if applicable, will take diagnostic and lab tests, as well as X-rays/MRI/CT scan to determine that you’re healthy enough for surgery as well as rule out any reason why you are not an ideal candidate. 

The procedure is performed as a two-part process. The first phase is the trial period and, if deemed successful, the second phase is the permanent placement of the device. Both phases are performed as an outpatient procedure, meaning that you’ll be able to return home the same day, and take two hours from start to finish. 

How the stimulator works is by attaching one or more electrical leads into the epidural space in the spine. The leads are soft, thin wires with conductive contacts near the tip. They connect to a pulse generator that creates the electrical current that will stimulate the spinal cord. The location of the leads can vary, but for most people the most helpful place is in the back around the same level as the lower edge of the sternum. 

During the first phase, the patient will be lightly sedated. The provider will make a small incision in the back and will use X-ray guidance to insert a special needle through the incision into the epidural space. Once the desired location has been reached, the provider will thread the temporary leads through the needle before removing the needle. The external end of the lead will be connected to a pulse generator, which is attached to the skin using skin glue or a suture. The provider will then program the generator and begin testing the effectiveness of the device. The trial period could last anywhere from a few days to a few weeks. It is deemed successful if the patient’s pain level has decreased by at least half. The majority of patients who undergo this procedure do deem it a success. 

The second phase of the procedure is the permanent implantation of the generator. The leads are placed in the same area as the trial period, but now the end of the lead is positioned under the skin and connected to the generator, which is placed under the skin via a small, pocket-like space the provider created. Most generators are placed around the waist area so it’s easy to reach. The generator is about the size of a box of matches and is only slightly visible. Once the procedure is over, the provider will give the patient a handheld remote and instructions on how to use it to manage the amount of stimulation and subsequent pain relief. 

Recovery is minimal. Patients are instructed to rest for the following day after the trial surgery, and to perform only light exercise for about a month after the permanent surgery.  

What are the Benefits and Risks of Spinal Cord Stimulation?

The main benefit of spinal cord stimulation is immediate and profound pain relief for patients who are living with chronic pain and haven’t been able to find relief from other conservative methods. Patients are able to enjoy a pain-free life without having to rely on taking medications for extended periods of time. It is also a proven method for treating a wide variety of pain, including heart-related chest pain, nerve pain, and spine or back pain. 

As with any medical procedure, there are risks. However, the risks are lessened by providers who utilize X-ray guidance to precisely place the leads and generator as needed. Overall, there are very low risks for this particular procedure. These include: 

• Bleeding and infection at the incision site
• Scar tissue
• Device failure
• Leads moving, breaking or malfunctioning
• Gradual loss of pain relief

What are Other Options for Neurostimulation?

Due to the fact that neurostimulation has been growing in popularity since the 1960s, there are now several options available. In addition to spinal cord stimulation, pain management specialists are able to recommend other devices to help patients find the needed pain relief for their particular situation. Some of the most common devices include: 

• Transcutaneous Electrical Nerve Stimulation (TENS unit): a small device that delivers the electrical current through patches placed on the skin, targeting the nerves under the skin that are believed to be causing pain, and blocking the feelings of pain. This is helpful for treating osteoarthritis, tendonitis and fibromyalgia. 
• Peripheral nerve stimulators: similar to a spinal cord stimulator, a device is implanted under the skin, but the difference is that this method targets the nerves outside the spine or the head. 
• Dorsal root ganglion (DRG) stimulation: by targeting a specific dorsal root ganglion, which is a bundle of nerves that branches off of the spinal cord, patients are able to receive stimulation to a particular region of the body where pain is being experienced, such as the hands or the feet.

Stimulation, which is generally constant, can also be delivered in bursts or high-frequency stimulation. The goal is to provide pain relief but not the associated paresthesia, which is the mild tingling sensation. Burst stimulation is delivered in a quick period of stimulation, then no stimulation, repeated. It has shown useful in disrupting pain signals as well as, or even better than, constant stimulation, but without any paresthesia. High-frequency stimulation delivers stimulation at a very high frequency, usually 10,000 cycles per second versus the usual 10 or few hundred cycles per second. While pain relief isn’t immediately felt, within hours the relief is greater and lasts longer than other neurostimulation devices.

The good news is that improvements are always being made to neurostimulation devices with the goal to help patients comfortably receive needed pain relief. These improvements include: 

• Smaller devices: smaller leads under the skin, and placing the battery and pulse transmitter above the skin by using a patch are currently being tested. These improvements should help reduce the already low risks of the procedure. 
• Greater coverage: even though the benefit of stimulation devices is that it targets the nerves believed to be sending pain signals to the brain, not all stimulation devices can reach difficult areas. The goal is to have improved coverage so that patients who are experiencing pain in their toes, fingers, etc. can experience relief. 
• Increased comfort: even though the stimulation is a welcome relief to the feelings of pain, healthcare providers are always looking for ways to have patients experience pain relief in the most comfortable way possible. Some patients find the mild tingling sensation uncomfortable, so the hope for future devices is that the pain is removed without replacing it with any sensation. 

The best way to determine which option of neurostimulation is best for you is to partner with a trained pain management specialist who is versed in all options. A spinal cord stimulator has proven most effective for treating chronic pain throughout different parts of the body, especially when other conservative treatment options have failed. It offers patients a comfortable and minimally-invasive way to finally enjoy a pain free life for an extended period of time. 

If you are suffering from chronic pain and have yet to find long-lasting relief, please reach out to the Nevada Advanced Pain Specialists in the Reno, Sparks and Carson City areas today. Our team can review all neurostimulation devices available and can help choose which device works best for your level and location of pain, as well as your lifestyle and activity goals. Please schedule an appointment today.

Trial Implantation

Implanting the Spinal Cord Stimulator is typically done using a local anesthetic and a sedative at our comfortable office in Reno, NV. Your doctor usually will first insert a trial stimulator through the skin (percutaneously) to give the treatment a trial run. (A percutaneous stimulator tends to move from its original location, so it is considered temporary.) If the trial is successful, your doctor can implant a more permanent stimulator. The stimulator itself is implanted under the skin of the belly (abdomen), and the small coated wires (leads) are inserted under the skin to the point where they are inserted into the spinal canal. The leads are inserted through an epidural needle or through a small incision into the space surrounding the spinal cord, called the epidural space. This placement in the abdomen is a more stable, effective location.

Find the Right Location

Electrodes at the end of the lead produce electrical pulses that stimulate the nerves, blocking pain signals. The patient gives feedback to help the physician determine where to place the spinal cord stimulators to best block the patient’s pain. The lead is connected to an external trial stimulator, which will be used for approximately one week to determine if SCS will help the patient.

Determine Effectiveness

The trial typically lasts around seven days. If the patient and physician determine that the amount of pain relief is acceptable, the system may be permanently implanted. At the end of the trial implantation, the lead is removed.

Permanent Implantation

The permanent spinal cord stimulator implantation may be performed while the patient is under sedation or general anesthesia. First, one or more permanent leads are inserted through an epidural needle or small incision into the predetermined location in the epidural space.

Battery Implantation

Next, a small incision is created, and the implantable pulse generator (IPG) battery is positioned beneath the skin. It is most often implanted in the buttocks or abdomen. The lead is then connected to the IPG battery.

End of Procedure

The implant’s electrical pulses are programmed with an external control unit. The patient can use the external control unit to turn the system on or off, adjust the stimulation power level and switch between different programs. After this outpatient procedure is complete, you and your doctor determine the best pulse strength. You are then told how to use the stimulator at home. A typical schedule for spinal cord stimulation is to use it for 1 or 2 hours, 3 or 4 times a day.

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