How Do Spinal Cord Stimulators Work?

The spinal cord stimulator is a small device surgically placed in the spine. The device has small threads or leads that are placed in the lower back region, between the spinal cord and the epidural space, more commonly known as the vertebrae.

The device delivers mild electrical impulses to the spinal cord, which alters the pain signals sent to the brain. This technique masks the pain signals, providing patients with relief. SCS is viewed as an alternative to traditional pain management techniques, such as opioids, and has a lower risk of addiction or overdose. The implantation of the device is done by a surgical procedure and is considered minimally invasive.

Patients can manage their pain symptoms with a small remote that gives them more control over their pain levels. Using the spinal cord stimulation remote is a straightforward process. The device is small and has a few buttons that patients can use to adjust the intensity of the electrical stimulation.

All patients are given clear instructions on how to use SCS remote, and our team of medical professionals can also provide guidance and assistance as needed. With proper use, SCS spinal cord stimulation remotes can give patients a high degree of control over their pain and improve their range of motion.

Is Spinal Cord Stimulation Right For You?

When experiencing chronic back pain, seeking a pain management specialist's guidance is crucial. At Pain and Spine Specialists, we provide you with the most effective pain management solutions tailored to your specific needs.

Take a look at an overview of our comprehensive consultation process:

Review of Medical History

Your journey begins with a thorough review of your medical history. We believe that understanding your past health experiences is vital in diagnosing your present condition accurately. Our team will thoroughly scrutinize all relevant information, including previous illnesses, treatments, surgeries, allergies, and lifestyle habits. This comprehensive insight into your health background enables us to identify potential causes of your pain.

Physical Examination

Next, we conduct an in-depth physical examination. We assess your posture, mobility, physical strength, and the areas where you experience discomfort. This hands-on approach allows us to detect abnormalities and helps us better understand the nature of your pain.

Diagnostic Imaging

To further enhance our understanding of your condition, we employ advanced diagnostic imaging techniques such as X-rays, MRI scans, and CT scans. These tools offer us a detailed view of your body's internal structures, enabling us to pinpoint the exact source of your pain.

Nerve Tests

In some cases, we may recommend nerve tests. These tests help us measure the electrical activity in your nerves and muscles, providing valuable insights into how well your nervous system functions. This can be especially helpful if we suspect a nerve-related issue is causing your pain.

Diagnostic Nerve Blocks

In certain situations, we might suggest diagnostic nerve blocks such as facet joint injections, epidural steroid injections, SI injections, or medial branch blocks. These procedures temporarily numb specific nerves, helping us determine if they are the source of your pain.

All these steps lead us to decide whether spinal cord stimulation could be a suitable treatment option for you. We are committed to ensuring you understand each step of the process, and we encourage you to ask questions at any time.

Nonsurgical Treatments Often Tried First

After diagnosing your condition, we typically recommend nonsurgical treatments such as medications, physical therapy, or steroid injections before considering SCS therapy. If these treatments do not provide sufficient relief, spinal cord stimulation may be the next step. Our specialists will review the benefits of the device and any potential risks you may incur, and they will then advise you on the necessary steps to have the device implanted.

What Conditions Does Spinal Cord Stimulation Treat?

Spinal Cord Stimulation (SCS) is typically used to treat chronic pain conditions that have not responded well to other treatments. 

• Complex Regional Pain Syndrome: CRPS is a neurological condition, often caused after injury or surgery, that results in severe chronic pain in the extremities. Spinal cord stimulation can help manage the severe and debilitating pain associated with complex regional pain syndrome by interrupting the pain signals before they reach the brain.

• Diabetic Peripheral Neuropathy: Diabetic peripheral neuropathy (DPN) is a type of nerve damage that primarily affects the nerves in the feet and legs, but can also occur in the arms and hands. In many cases, spinal cord stimulation emerges as the best treatment for diabetic peripheral neuropathy.

• Peripheral Nerve Entrapment: When a nerve outside your brain or spinal cord gets compressed, injured, or irritated, spinal cord stimulation can provide relief by sending low-level electrical signals to the specific nerves affected, blocking the pain signals from reaching your brain.

• Lumbar Spinal Stenosis: Lumbar spinal stenosis is a condition where the spinal canal in your lower back is narrowed. This narrowing puts pressure on the nerves, causing pain. Spinal cord stimulation can help manage this condition by modulating the perception of pain, providing potential relief from the discomfort associated with lumbar spinal stenosis. 

•  Degenerative Disc Disease: Degenerative disc disease is caused by the natural wear and tear of aging. This is one of the most common causes of people experiencing lower back and neck pain. Spinal cord stimulation can help control the associated pain by disrupting the pain signals before they reach the brain, offering a nonsurgical method to manage this condition.

• Sciatica Nerve Pain: Pressure or damage to the sciatic nerve can result in sharp, shooting, or stabbing pain. Spinal cord stimulation can help manage sciatica by sending low-level electrical signals to the spinal cord or specific nerves to block pain signals from reaching your brain.

• Fibromyalgia Pain: Fibromyalgia is a disorder that often causes pain, fatigue, excessive sleeping, difficulty with memory, and mood shifts, fibromyalgia can disrupt even the simplest everyday task. SCS treatment can modulate the body's perception of pain, providing relief from the widespread discomfort associated with this condition.

• Failed Back/Neck Surgery Syndrome: When a patient has not had a successful result from surgery and continues to experience pain, it's known as failed back or neck surgery syndrome. Spinal cord stimulation can help manage the persistent pain that persists after surgery.

• Vertebral Compression Fracture Pain: When the bones of the spinal column weaken, it leads to hairline fractures in the vertebrae and the eventual collapse of this system. SCS can help relieve the chronic pain that often follows such injuries.

•  Neuropathy Or Neuralgia Pain: Conditions that affect our nerves and can often lead to feelings of pain, numbness, tingling, swelling, or muscle weakness, also known as neuropathy or neuralgia. Spinal cord stimulation can interrupt pain signals from damaged nerves, offering potential relief.
  

• Chronic Headache Pain: Headaches and migraines are often related to stress, depression, and anxiety. SCS can help by blocking the pain signals that cause this type of pain.

• Arthritis Related Pain: A chronic joint inflammation condition causing pain, stiffness, and swelling related to arthritis can be managed through medication, physical therapy, and lifestyle modifications. Additionally, spinal stimulation can help manage chronic joint pain and improve mobility.

• Pain Bulging And Herniated Discs: Herniated discs occur when the vertebrae protrude or rupture, causing pain, discomfort, and potential nerve compression. The SCS procedure offers a non-surgical method to control the associated pain by disrupting pain signals before they reach the brain.

It's important to note that using SCS for these conditions is only sometimes appropriate, and a qualified healthcare provider should make the decision to use SCS as a treatment option on a case-by-case basis.

Is SCS a Good Alternative to Opioids?

Spinal cord stimulation is considered to be an excellent alternative to opioid pain management for some patients. Opioid pain medications can be effective in managing chronic pain, but they also carry a risk of addiction, dependence, and other side effects. SCS, on the other hand, provides pain relief by using electrical impulses to disrupt pain signals to the brain without needing medication.

SCS can also be used in conjunction with medications for pain management. Many patients who undergo spinal cord stimulation continue to take medications, although in many cases, patients are able to reduce their usage or stop altogether.

Spinal cord stimulation is often used as part of a multimodal pain management approach, which may include medication, physical therapy, and other treatments. Using SCS in combination with medication can provide patients with more effective pain relief, allowing them to achieve a better range of motion.

Starting the Process for an SCS

Once you decide to move forward with a spinal cord stimulator, there are a few steps you must follow. The initial part of the process requires you to schedule a psychological evaluation. This psychological evaluation is administered before the trial to determine if there is any mental health risk due to SCS placement. 

Some patients do not respond well to a foreign device being surgically implanted in their body. For those individuals, a surgically placed device may heighten anxiety and worry.

Elevated stress levels may negatively impact the effectiveness of the spinal cord stimulation, and you may continue to feel pain in the same manner. Since SCS requires surgery for placement and use, a psychological evaluation is vital for all parties involved to ensure the patient will receive the best outcome possible.

If the psychological evaluation indicates that a patient is not emotionally capable of handling the placement of the device, then we cannot proceed with the procedure. Fortunately, there are alternative treatments to spinal cord stimulation that can then be considered during a follow-up consultation.

The psychological evaluation must be completed by a mental health professional, who will review basic information, medical history, and your struggle with chronic pain. Once the mental health professional has completed their evaluation and determined you are a good fit, you are able to proceed to the next steps.

The SCS Trial Procedure

Once an individual has completed their psychological evaluation, they proceed to a trial spinal cord stimulation period.

With the spinal cord stimulator trial, patients can experience the benefits of SCS without undergoing full surgery. This trial period allows patients to test-run the device at home and evaluate their pain relief. The trial will last roughly three to five days, allowing you to determine if the pain symptoms are subsiding. If you experience a 50% reduction in pain or more, the SCS trial can be considered a success.  

Spinal Cord Stimulator Trial Procedure:

The trial SCS is an outpatient procedure. During the spinal stimulator trial procedure, your pain management doctor will place the temporary SCS trial implant using fluoroscopy.

Fluoroscopy is a medical imaging technique that uses X-rays to create real-time moving images of the internal structures of a patient's body. It is often used to assist doctors during surgical procedures, allowing them to see the inside of the body and guide their instruments with precision. 

Based on the location of your pain, the SCS trial leads will be carefully and precisely placed in specific portions of your epidural space, which is the area surrounding the spinal cord. 

Spinal cord stimulation leads are thin wires that are connected to a small device called a spinal cord stimulator, which delivers electrical impulses to the spinal cord. These impulses are what interfere with the pain signals that are sent to the brain.

For the SCS trial, the stimulator device will not be surgically implanted inside the body; only the lead wires will be placed fluoroscopically.

Spinal Cord Stimulator Implant And Lead Placement

After a successful spinal cord stimulation trial, you can move forward with a permanent implant procedure. The procedure requires minimally invasive surgery, but surgery nonetheless. 

Please note that a permanent spinal cord stimulation implant can be removed in the future if necessary. Reasons for removal may include a change in the patient's medical condition or if the device is no longer effectively controlling the patient's pain.

SCS Procedure Steps:

1. 1

   Preoperative Preparation: The patient is prepared for surgery, which involves cleaning the area where the generator will be implanted and administering local anesthesia to numb the area.

2. 2

   Placement of the Leads: Our doctors will make a small incision in the patient's back, carefully insert the leads through a needle or catheter, and place them in the epidural space surrounding the spinal cord. The leads are then secured in place with sutures.

3. 3

   Placement of the Generator: Once the leads are in place, a small incision is made near the hip or abdomen, and the generator is implanted under the skin. The surgeon then connects the leads to the generator and tests the system to ensure it works correctly.

4. 4

   Closing the Incisions: After the generator is in place, the surgeon will close the incisions with sutures or surgical staples and cover them with a sterile dressing.

5. 5

   Postoperative Recovery: After the procedure, the patient is taken to a recovery area, where they are monitored for a short period before being released. The patient can usually go home the same day or the day after the surgery.

Spinal Cord Stimulator Recovery Time

Following a Spinal Cord Stimulator procedure, it is important to be aware of potential risks and side effects. As with any surgical intervention, there may be risks such as infection, swelling, bleeding, or allergic reactions. Some patients may also experience discomfort at the site of the implant. However, these occurrences are rare, and our team is well-prepared to manage and minimize these risks.

The First Few Weeks

Recovery from this procedure will take a shorter amount of time than other standard spinal surgeries. Postoperatively, you may resume light activities after a few weeks, with a full recovery typically after eight weeks.

Your surgeon and pain specialist will monitor your recovery to ensure you have a successful outcome from SCS implantation. For many patients, the mild electrical impulses that alter and mask the pain signals are a significant reprieve from their previous pain experiences. Instead of pain radiating through your back, the sensation changes to something manageable.

The pain-relieving stimulation can be flexibly programmed for appropriate therapy to provide a gentle tingling sensation. A mild tingle wins over the pain that radiates.

Long-Term Recovery

Our pain management doctors diligently monitor your progress. We focus on assessing the effectiveness of the treatment by observing changes in your pain levels, mobility, and overall quality of life. Regular follow-up appointments will be scheduled, where we will discuss your experiences, answer any queries, and adjust your treatment plan if necessary. Our approach is not just about treating pain but about ensuring a safe, personalized, and ethical treatment process that resonates with your unique health needs.

We understand that pain management is not a one-size-fits-all solution. Don't get discouraged if you don't experience adequate relief with spinal cord stimulation. Our providers have extensive knowledge and experience in a broad range of pain management techniques.