Spinal Cord Stimulation (SCS)


 

The pain just will not go away. You have taken non-steroidal anti-inflammatory drugs (NSAIDs) like Advil, Motrin, and Aleve. You have participated in physical therapy, but sometimes that made the pain worse. And the pain is worse now than it was six months ago when you injured yourself. Even stranger, sometimes you feel pain in places that were not injured! You aren’t a candidate for surgery, and even if you were, your doctor does not think it would treat your pain. You have tried everything! Your pain is starting to really affect your way of life--it is taking an emotional toll. You do not know what to do! Now what?

If the above scenario describes your circumstances, you may be a perfect candidate for spinal cord stimulation therapy (SCS). Several chronic intractable pain conditions are completely treatable with SCS. First of all, arachnoiditis is the inflammation of the arachnoid. The arachnoid is one of three linings that surround and protect the spinal cord and brain (the central nervous system). When it becomes inflamed or irritated you have arachnoiditis. This condition is marked by numbness, tingling, pain or burning in the legs and lower extremities. In addition, it can cause kidney/bowel/sexual dysfunction. The irritation can be brought on through some kind of bacterial or viral infection, an injection near the spinal cord, or other invasive spinal cord procedure, including surgery. Unfortunately, there is no cure for arachnoiditis, so the only treatment is to control pain.

Another pain disorder is called complex regional pain syndrome (CRPS). It is marked by chronic intractable pain that lasts six months following an injury, surgery, heart attack or stroke. Pain occurs in all forms with this disorder--hurting, tingling, burning, numbness and inflammation. CRPS does not respond well to NSAIDs or physical therapy.

A third pain chronic condition is failed back surgery syndrome (FBSS). This condition causes pain in the back and legs after a surgery. The diagnosis if one of the exclusions--that means a magnetic resonance image (MRI) or computerized tomography scan (CT) shows that there is no other cause of the pain you are feeling. In addition, patients often have scar tissue that does not respond well to surgery, so SCS would be the best option. A final condition marked by chronic pain is nerve damage or neuropathy. This condition occurs when the peripheral nerves themselves are damaged somehow--there is a myriad of ways this can happen. What’s important are the symptoms: pain, numbness, tingling, pins-and-needles, and even weakness are consistent with neuropathy. The exact symptoms will depend on the nerves that are damaged. Other conditions that can be treated by spinal cord stimulation therapy include spinal stenosis, sciatica, degenerative disc disease, and nerve root compression.

So, you get a diagnosis of one of the above conditions. Your doctor may very well recommend spinal cord stimulation therapy. This therapy involves sending an electrical impulse to the spinal cord that masks the pain you are feeling.  Your doctor will pinpoint where to implant electrodes that when hooked to a small battery implanted under the skin will send electrical impulses to the surrounding nerves thereby eliminating, or at least vastly reducing, the sensation of pain. The conventional system is easiest for you! Once the electrode and battery pack are implanted, you will experience a reduction in pain symptoms until the battery needs to be replaced. Another system is the radiofrequency system. This system is reserved for patients with widespread pain. It puts out the maximum possible stimulation through an external device the patient wears to activate stimulation. The last SCS system is the newest type--rechargeable systems. With this, patients recharge the power source when necessary. This type of SCS is designed to last for the longest amount of time.

How does SCS work?

Since the firing of neurons and the sensing and interpreting of nerve signals is an electrochemical process, these sensations respond to electricity. SCS takes advantage of that. Your doctor will implant a device that has electrodes in the epidural space of your spinal cord. These electrodes are hooked to a small battery that is sometimes implanted just under the skin. The battery then sends electrical signals through the electrodes. The low-voltage electricity interferes with your brain’s perception of pain. The pain is usually replaced with a slight tingling sensation, but some patients do not feel anything. Depending on the system your doctor employs, you can control the amount of stimulation you receive. Most of the time, your doctor will recommend a trial period in which you wear a temporary device to determine how much stimulation your pain responds to.

For the procedure, you are slightly sedated. Your doctor will apply a local anesthetic to begin the procedure. If there are any trial leads, these will be removed. Then your doctor will implant the permanent device most likely putting you under general anesthesia. Once the power source and leads are implanted, your doctor will ensure they are working properly. Then he/she will close the incisions and you will be led to recovery. Most of the time patients are released the same day. Your doctor will ask you to avoid stretching, lifting and bending for a time, but some walking will be helpful in promoting your recovery. While you may experience incision pain, you will most likely wake up pain-free after the procedure.

What are the risks of SCS?

Since SCS is completely reversible and there are no long-term medications involved, there is little risk to the central nervous system or internal organs. There is a risk of infection at the incision site. You might experience an allergic reaction to anesthesia or headache. In addition, you will probably experience bleeding at the incision site. Some rare risks include weakness, worsened pain and paralysis. SCS specific risks include device malfunction, overstimulation, and possibly damage to the leads or power source that require another surgery.

What are the outcomes of SCS?

More than 60% of patients experience pain relief, according to the American Association of Neurological Surgeons. However, most patients who experience the greatest amount of pain relief began spinal cord stimulation therapy within two years of developing their pain. In fact, 75% of those patients reported a dramatic reduction in pain while only 15% reported significant pain reduction when undergoing SCS treatment after two years of the onset of pain.

Unfortunately, not every patient experiences pain relief with SCS therapy. So, the trial period of spinal cord stimulation therapy is important--if the patient doesn’t respond to treatment in the trial period, then he/she can find an alternative without undergoing the more permanent procedure.

Conclusion

Spinal cord stimulation therapy offers patients who suffer needlessly with chronic a chance to experience life again! Intractable pain can be debilitating and emotionally taxing; finding relief allows these people to step back into their best life possible. SCS is relatively risk-free, noninvasive, and completely reversible. It works extremely well in patients who haven’t felt relief using conventional treatments. With therapies like spinal cord stimulation available, you can find relief from the pain, numbness, and weakness and start living your best life! Talk to your doctor about SCS, let go of your pain and take hold of life again!

If you’d like to learn whether spinal cord stimulation might be able to help you, make an appointment with Dr. Jay M. Shah of SamWell Institute for Pain Management. Call either office in West Orange or Colonia, New Jersey, or book an appointment online.

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