NINE THINGS YOU MUST ABSOLUTELY KNOW
ABOUT SPINAL CORD STIMULATION

Spinal cord-stimulation, also called dorsal column stimulation, is the ninth step of treatment on the World Health Organization’s eleven-step hierarchy of treatments for chronic pain. “Spinal cord stimulation is the most powerful and advanced treatment available for chronic, neuropathic pain (Sata, 2005).” All patients with chronic neuropathic (nerve-based) pain are candidates for this powerful treatment. Spinal cord stimulation provides pain relief by electrically stimulating the painful area to block pain perception. The spinal cord stimulator masks the pain signal by providing a different type of signal down the nerve fibers.

With the dorsal column stimulator, electrical leads are placed at the junction of the spinal cord and selected nerve roots that exit toward the arms or legs. A generator or battery unit is also implanted in the body, usually at the hip or between the shoulder blades, connected to wires that attach to the leads. Thus, the implanted device, wires, and leads are all fully internal. The spinal cord stimulator transmits electrical energy down a nerve to produce a sensation of warm vibration in the affected area that effectively masks pain.

If you have neuropathic pain, you are a good candidate for spinal cord stimulation. If you have neuropathic pain in your arms and legs, you are a better candidate for stimulation. If you have neuropathic pain in your arms only or legs only, you are an even better candidate. If you have neuropathic pain in only one arm or leg, you are the best possible candidate for the dorsal column stimulator.             

Spinal cord stimulation is the last best chance for dramatic pain relief in patients with:

• Neuropathy

• Reflex Sympathetic Dystrophy (RSD)

• Complex Regional Pain Syndrome (CRPS)

• Neuralgia

• Trigeminal Neuralgia

• Post-Herpetic Neuralgia

• Sciatica

• Diabetic Neuropathy

• Peripheral Neuropathy

• Neuropathic Pain

• Radiculopathy

• Sympathetically Mediated Pain

• Phantom Limb Pain.

Spinal cord stimulation works by using an individual nerve fiber’s all-or-none, digital firing, i.e., a nerve fiber can only send one type of signal at a time. Unfortunately, all the affected nerve fibers cannot be stimulated—only some percentage of the fibers—so, dorsal column stimulation rarely provides 100% pain relief.

We cannot know what percentage of pain relief your body will uniquely obtain from spinal cord stimulation until we perform a trial period of stimulation. To do this, a small incision is made over the spine, and leads are placed with wires that extend externally to a generator inside a fanny pack. For about a week, you will engage in your regular activities, and assess the effectiveness of pain control and increased function from the stimulator. Fifty percent pain reduction with the same activity and medication level is considered a successful trial. A lower percentage of pain relief is acceptable if you are more active and have reduced medication consumption.

After the trial is over, the leads are removed, and the small incisions are allowed to heal for a few weeks. If the trial was successful, at that time, your doctor will proceed with the permanent implant. You will need about two to eight weeks to recover fully from the spinal stimulator implant, during which time you should carefully watch your activity, so you don’t fall hard, or twist your body in a way that could dislodge the leads.

You will receive a remote control device that functions similarly to a garage door opener. You can turn the stimulator on and off or change the force and intensity of stimulation depending on your activity and pain. Some patients find that the stimulation intensity varies with their position (sitting, standing, walking, or lying down). You can program different settings at the touch of a button. The generators last from two to ten years, depending upon the manufacturer, the type of stimulator, and whether or not it is rechargeable. When the generator wears down, it must be replaced. A small incision is made where the generator was placed, and only the generator is removed and replaced—the wires and leads are not affected.

Spinal cord stimulation, or dorsal column stimulation, has been around for thirty years and is used by over a million people. I have assessed or treated over a thousand stimulator patients. I have never seen a catastrophic outcome from the trial or implant procedure. I have seen a small percentage become infected which required removing the stimulator. A small percentage of patients found that it never worked properly and required removal. Another small percentage of patients had leads that dislodged slightly, couldn’t be re-programmed to full effectiveness, and required removal. I would estimate that 10-20 percent of patients report long-term soreness at the generator site; well worth tolerating for fifty percent or more pain relief. There is research evidence to suggest that about one-third of patients report a slight decrease in stimulation effectiveness after about a year.

If you would like more information about the process, or likely outcome of spinal cord stimulation, please feel free to arrange a consultation with Dr. Tim.     

More Information about PRISM Topical Analgesics

MyPainReliefDoc.com is your resource for: chronic pain, back of knee pain, chronic back pain, fibromyalgia pain, chronic pain coping strategies, relief from joint pain, questions about living in pain, spinal cord stimulation, muscle pain, natural pain relief, chronic pain relief, relief from arthritis pain, any type of pain relief, and phone consultations with Dr. Tim Sams.