About Spinal Cord Stimulation
Spinal Cord Stimulation, or SCS, is a novel way to manage difficult pain conditions, such as: Failed Back Surgery Syndrome (FBSS), Complex Regional Pain Syndrome (CRPS), Diabetic Peripheral Neuropathy (DPN), other refractory chronic pain conditions. In these conditions, the nervous system is injured and inappropriately relays pain signals to the brain via the spinal cord. The pain is often amplified as the nervous system is recovering from injury like a “live wire,” and the recovery is often incomplete. SCS involves an artificial device that aides the struggling nervous system by stimulation of the spinal cord with small electrical fields to normalize the amplification of pain. The painful sensation is replaced with a soothing, tingling sensation or is diminished. Thousands of patients with severe chronic painful conditions such as the above have received relief with spinal cord stimulation. More importantly, since pain changes throughout the day and with activity, SCS allows the individual patient to adjust the device in real-time to mitigate changes in pain. Thereby, SCS improves function and quality of life. This is unique compared to other injections and medications. SCS is performed by specially trained physicians. The doctors at WCPM are all specially trained and experienced to perform this procedure.
About the Procedure
Spinal Cord Stimulation involves two phases: Trial and Permanent Implantation.
Having two phases offers a unique advantage to the patient and improves outcomes and efficacy.
The first phase is a temporary trial and allows the patient to experience what stimulation can do for their pain. It also allows the doctor to assess the best location and parameters to help the patient. Therefore, it allows the patient to “test drive” SCS. It is comparable to an epidural steroid injection except no medications are given through the needles. Instead a special catheter is threaded through the needle to the appropriate area of the spinal column to treat the pain. There is no direct communication to the spinal cord. A small electric field from the catheter in the epidural space influences and diminishes pain signals in the spinal cord. Once the appropriate mapping is done by the doctor, the catheters are left in place and the needles are removed from the patient’s back. The patient goes home for a few days with a special dressing to really assess the benefits of SCS. If the trial is beneficial, the patient and physician decide to move on to the second and last phase of SCS.
Implantation involves the same technique as the trial. Needles are initially utilized to introduce special catheters into the epidural space. The catheters are advanced to the area of the spine that was determined by the trial. However, at this time a small incision is made in the back to keep the catheters secured under the skin once the needles are removed. This allows the catheters to stay in position for optimal pain control. Since this is an electrical system that is programmable, the catheters have to communicate with a programmer/battery. Therefore another small incision is made usually in the buttock or flank area of the back to secure the battery under the skin and communicate with the catheters. The battery, also known as internal pulse generator (IPG), is the “brain” of the system. The IPG allows the patient to communicate with the catheters by using a remote control to adjust pain control when needed. This feature also allows the doctor to modify and program the device further throughout the life of the IPG. IPGs are the same size as heart pacemaker batteries or roughly the size of an oreo cookie.
Once installed, the patient needs a few weeks of post-procedure restrictions to heal completely before being released to activities as usual. At this time, the patient will hopefully experience lower pain levels and higher functional levels. SCS has helped all kinds of patients, including professional athletes. If you have questions about this procedure please schedule an appointment with the doctors of Washington Center for Pain Management.