Chronic back pain develops when the body’s appropriate response to an injury lasts longer than it should. Once the pain starts, it can interfere with work, exercise, eating, or a variety of other daily activities. Over time, back pain can cause other chronic health problems like depression, anxiety, and weight gain. Some patients even experience issues related to medication overuse to manage the discomfort.
Nerve signals are transmitted constantly from the body to the brain. This process helps prevent injury by making the person aware that something is wrong. When nerves are damaged, they can send pain signals to the brain even if an injury is not occurring. Spinal cord stimulation (SCS) blocks the brain from receiving those important signals.
Please note, this article is for informational purposes only. If you are experiencing chronic back pain, speak with a medical professional before planning your next steps.
What is a Spinal Cord Simulator?
As a newer treatment alternative for chronic back and neck pain, a spinal cord stimulator is a small medical device, much like a pacemaker, that utilizes electrical impulses to mask pain signals before they reach the brain.
The device is implanted inside of the body via a needle or small surgery inserted in the back close to the spinal cord. The pulse generator (battery) is then placed under the skin in the upper buttock through a small incision.
Once activated, the stimulator sends electrical signals to the leads to mask pain signals. The patient has the ability to turn the current off and on or adjust the intensity of the signals.
What Spine-Related Problems are Treatable with SCS?
Determining if you are a candidate for a spinal cord stimulator will mainly depend on what’s causing the pain. Spinal cord stimulation (SCS) is widely accepted treatment option for patients experiencing neuropathic pain caused by a pinched or injured nerve.
Additionally, any patient with mechanical back pain caused by these conditions may be an ideal candidate for SCS:
- Degenerative disc disease
- Radiculopathy (pain that travels down a leg or arm)
- Spinal stenosis (when the spinal canal narrows)
- Lingering pain following back surgery or a failed back surgery
- Sciatica
Spinal cord stimulation can also successfully treat these medical conditions:
- Complex Regional Pain Syndrome (CRPS)
- Arachnoiditis
- Multiple Sclerosis (MS)
Note: SCS is not recommended for the treatment of numbness or weakness nor is it useful for treating pain resulting from a bone fracture or cancer.
When Should a Trial of SCS Be Considered in a Person with Chronic Pain?
Spinal cord stimulation is recommended for patients with chronic pain that has persisted for over 6 months to 1 year and has failed to resolve with other treatments like physical therapy, injections, and medication management.
SCS is also suggested for situations when surgery is not likely to help, or when surgery has already failed. For example, patients with chronic neck pain who have undergone a failed cervical spine surgery may benefit from using a spinal cord stimulator. Several recent studies have also shown that patients with axial low back pain with or without leg pain may find pain relief by using a spinal cord stimulator.
In specific cases, such as patients with CRPS, it is recommended SCS be used even sooner because the success rates drop significantly if pain persists for longer than a year. This occurs when the pain pathways become rewired in individuals with CRPS for over 1-2 years, making it much more difficult to reverse or improve the condition.
However, each patient should undergo an SCS trial before implanting the device to ensure that the treatment provides them with pain relief.
What if the trial fails?
Unfortunately, patients desperate for relief may still request SCS implantation even if they have responded poorly during the trial. Anytime the SCS trial is unsuccessful, the device should not be implanted. In those cases, other pain management treatments should be offered instead.
What Types of Physicians Use SCS in the Treatment of Chronic Back and Neck Pain?
SCS is most often used by pain management physicians such as anesthesiologists, orthopedic surgeons, neurosurgeons, and physiatrists. Additionally, SCS is increasingly being used by neurologists for other conditions like occipital neuralgia (a form of severe headache), cardiovascular surgeons for intercostal neuralgia (rib pain following surgery), and general surgeons to treat nerve pain from hernias.
What Advice Do You Give Patients About Selecting a Physician Who is Knowledgeable About SCS?
It is important to be evaluated by a spine surgeon before being referred for pain management. Some conditions are repairable with conventional surgery and spinal cord stimulation should be a last resort.
What is the success rate of spinal cord stimulators?
While the results can vary from one patient to the next, the procedure’s long-term success rate ranges from 47% to 74%. Early implantation is necessary for better results. The amount of time that has passed between the onset of chronic pain syndrome and the moment of implantation affects the effectiveness of SCS.
Do spinal pain stimulators work?
Yes. However, effective trial stimulation, appropriate surgical technique, and excellent patient education are necessary for SCS’s lasting results. While it is important to note that the condition generating the pain cannot be cured by the stimulators, this procedure can aid patients in controlling their discomfort.
What are the disadvantages of a spinal cord stimulator?
A major disadvantage is that not everyone experiences the anticipated outcomes from spinal cord stimulation. This is one of the therapy’s biggest downsides. Some individuals get considerable pain relief, while others may get very little relief. Most patients will only see a decrease in their pain, not its complete eradication.
Device-related issues have been another typical drawback of this treatment. The most frequent issues are the unexpected movement of the leads, also known as migration, failed connections, and lead breakage. Although implant-related problems can occur, they are becoming less frequent as technology and surgeon competence improves.
Another drawback is that SCS doesn’t focus on the root cause of your discomfort. Instead, it aids in preventing the brain from receiving pain signals. Therefore, SCS will not treat the underlying source of your discomfort. If you have a condition that needs attention, we may have to advise actions to treat the underlying disease before using a spinal cord stimulator.
Are spinal cord stimulators worth the risk?
While some believe the implantation is worth any potential risks, many are also choosing to have their stimulators removed. For some, SCS does not work as miraculously as they had hoped.
This procedure has inherent hazards, just as any procedure involving foreign items in the body will. The implantation of a spinal cord stimulator is still a surgical process. It entails all the same risks as other surgical procedures, such as bleeding and infection, discomfort at the surgical site, weakness and numbness, migration of the device or electrodes, and diminished therapeutic efficacy. If you’re considering this procedure, the physicians at The Spine Center can go over all the risks and potential complications with you before making an informed decision.
What happens if a spinal cord stimulator doesn’t work?
Implanting a spinal cord stimulator can significantly improve the quality of life for many people. Still, these devices may not work for everyone. Mechanical failures, infection or a general lack of efficacy can all occur. Luckily, spinal cord stimulators can always be removed if desired.
Who qualifies for a spinal cord stimulator?
Spinal cord stimulation may not be ideal for everyone. It’s always best to consult with your physician to determine if you’re a good candidate. This procedure may be a good option if you struggle with lower back pain, leg discomfort, persistent pain following a back surgery, or complex regional pain syndrome (CRPS). Many people with these and other forms of nerve pain can experience at least a 50% reduction in pain and improved function with a SCS.
What kind of pain does a spinal cord stimulator help?
Spinal cord stimulation is most frequently employed when nonsurgical pain management alternatives are ineffective. In addition, a spinal cord stimulator helps address or manage various chronic pain conditions. This includes arachnoiditis, diabetic neuropathy, angina, peripheral vascular disease, phantom limb pain, and postherpetic neuralgia.
The majority of patients who are referred for SCS have previously tried other therapies, which is crucial. Therefore, this procedure frequently coexists with other pain management techniques such as medicine, physical activity, physical therapy, and relaxation techniques.
Who is a candidate for spinal cord stimulation?
The best candidates for SCS are often those who have suffered from lower back, leg, or arm discomfort for over 6 months to 1 year. Additionally, these people have generally undergone one or more spinal procedures. If you would not benefit from more surgery, or if other conservative treatments have failed, you could also be an ideal candidate for SCS.
Additionally, you might be the perfect candidate for Spinal cord stimulation if you had a successful SCS trial, have no medical issues preventing implantation and meet other criteria.
What Questions Should Patients Ask Their Physician When Considering Treatment with SCS?
Before agreeing to SCS treatment, be sure to ask your physician these questions first:
Are there any structural problems with my spine that should be addressed first?
- Sometimes, pain doctors refer patients for SCS when they have an underlying mechanical problem that an operation might correct.
What is your clinical experience with SCS?
- Try to work with a physician that has done 20 or more SCS procedures. Even better, find one who is currently involved in the research and development of spinal cord stimulation devices!
Are all spinal cord stimulators the same?
- Thanks to over three decades of clinical experience, more advanced spinal cord stimulator models are now available. A traditional stimulator uses tonic stimulation, where the patient might feel a tingling sensation much like a light massage in the area where they formerly felt pain. Burst stimulation and high-frequency stimulation are newer SCS forms that provide pain relief differently. Your doctor should present the various spinal cord stimulator types and discuss which options are right for you.
How long will a spinal cord stimulator last?
- Studies suggest that spinal cord stimulators relieve pain for up to 20 years, although the neurotransmitter’s battery does have an expiration date. Most batteries are rechargeable and can be recharged by holding a charger over the neurostimulator implanted under the skin.
Your Experienced Spine Care Specialists in Chicago
At The Spine Center, we’re dedicated to providing you with high-quality, personalized back and neck care. We strive to offer efficient and professional services to our patients, delivered with integrity and honesty in a state-of-the-art, family-like environment. We have a solid commitment to excellence in diagnosing and treating spinal injuries and conditions spanning all age groups.
As fellowship-trained physicians with over 50 years of experience treating spinal conditions, we provide patient advice for treatment, ranging from basic treatment to non-operative therapy and cutting-edge, personalized surgical procedures. Our physicians serve as innovators in technology, actively participate in national and international research studies, and are at the forefront of medical knowledge. If you or a loved one is suffering from back or neck pain, call The Spine Center today at (847) 628-8147 to schedule a consultation.