Spinal cord stimulation is at the beginning of a new era, with major advances in technology which will improve outcomes and which will increase the number of conditions for which we use stimulation.
Stimulators were usually used in cases of neuropathic pain, such as occurs after back surgery or with Complex Regional Pain Syndrome, although there are other indications, such as inoperable heart disease and peripheral vascular disease, where it is also useful.
Before having a stimulator implanted, we perform a trial of the device to see if you like it. This trial is very easily performed. The spinal cord stimulator lead is placed into the epidural space very much like an epidural catheter is placed, using just a needle. There is no cutting involved. Trials are quick and easy to do; the only thing which would prolong a trial would be if it takes a long time to locate the precise spot we want to stimulate.
After the stimulator lead or leads are placed, they are secured, with the leads being attached to a programmer that you can wear in a “fanny pack.” You will be given several different programs to use. You should spend the next several days using the different programs, finding out which you like the best.
We limit the length of the trial because we are concerned about the risk of infection if the leads are left in for too long. After your trial is over, you will have your leads removed in our Laguna Hills office. Lead removal is a quick, simple procedure.
If you find that during the trial, the spinal cord stimulator allowed you to function better, then we would proceed to a permanent implantation. Implantation involves placing the leads, anchoring them in your back so that they do not move, and placing a generator. We usually place a generator in the buttock, in the same area where a wallet would rest. Permanent placement is a surgical procedure; you may be uncomfortable from the procedure for up to 2 weeks after the procedure. You will, of course, be given both pain medication and antibiotics. In order to minimize the possibility of your leads moving from their optimal position, we will ask that you avoid activities that might move the leads, like reaching over your head or sitting up in bed. We recommend you roll out of bed.
Sometimes, instead of percutaneous leads inserted through a needle, we will use “paddle” leads, which are placed with a minilaminectomy by a spine surgeon.
Spinal cord stimulators are powerful, important tools in the treatment of pain; although they are not perfect devices. Sometimes, we obtain perfect coverage during the trial; however, despite stimulating the same area, we do not always get good coverage during the permanent placement. This is a frustrating problem for which there is not always an easy answer. Treating chronic pain requires perseverance.
New advances include stimulators where the batteries are on the outside. StimWave provides this exciting technology. This change means that we can now easily do peripheral nerve stimulation, in addition to spinal cord stimulation and peripheral nerve field stimulation. Another exciting change is the use of new stimulation patterns, with stimulation at frequencies up to 10,000 Hz, a level at which you do not feel any tingling. This approach has been proven effective in high quality trials and works well for back pain. Nevro provides this technology. A variant of this approach is burst stimulation, which more closely mimics the natural actions of the nervous system.
Another new target is the dorsal root ganglion. Targeting this structure allows us to have better control over foot pain and it can be very useful also for refractory knee pain.
StimWave is doing a clinical trial on high frequency stimulation. You may be a candidate. StimWave is also the only technology which can do all of these approaches.
Spinal cord stimulation, better called neuromodulation, is a rapidly evolving field which offers new treatment options.
Implantable medical devices, such as spinal cord stimulators are very powerful and very important parts of our treatment armamentarium. They allow us to treat problems that otherwise we would be unable to treat. Call the Helm Center today to schedule your consultation with one of our specialists.