Pain is an important sense, allowing us to navigate the world while avoiding mortal danger. But pain can also work against us, making life a living hell. For over 50 million Americans, pain has become an intrusive and debilitating part of their daily lives. Most Americans living with chronic pain experience lower back pain first and foremost, with hips and knees being common trouble areas as well.
Unfortunately, there is no straightforward or guaranteed path towards relief and recovery. But there are several different options to help a person with chronic pain find relief and work on decreasing their pain levels, one day at a time. From physical therapy to psychiatric medication and neuromodulation, different treatments can elicit positive responses and help people work on defeating their pain.
One of these treatments is spinal cord stimulation. Spinal cord stimulation (SCS) becomes an option when other pain treatments show no promising signs of improvement. As nerve-wracking as it might sound, spinal cord stimulation is quite simple and very safe. Spinal cord stimulation is deemed successful if it reduces pain by about 50 percent, and it has caused chronic pain to go away by as much as 70 percent in some cases.
What Is Spinal Cord Stimulation?
Spinal cord stimulation begins with a small electrical device implanted in the body and attached to the spinal cord. The device sends electrical signals through the spine into the brain, interrupting pain signals. The brain communicates with the rest of the nervous system through electrical signals and neurochemicals, both of which are responsible for every sensation in our mind. A spinal cord stimulation interrupts certain signals and may override them partially or completely.
Nerve stimulation is not always effective. Furthermore, some people are irritated by the tingling sensation sometimes present through low-frequency spinal cord stimulation.
While spinal cord stimulation can be effective in reducing pain significantly, it is important to remember that major improvements are not guaranteed. However, even a smaller reduction of pain may be enough to help you get moving again and feel better both physically and mentally through daily activity. Spinal cord stimulation does not affect the body’s strength but can help get you in the right headspace to be physically able again.
Is SCS Safe?
The FDA approves spinal cord stimulation as a way to reduce pain in the long-term. Spinal cord stimulation involves the use of a three-part device system, including a pulse generator, a lead wire with electrodes attached to specific nerve fibers in the spinal cord, and a hand-held remote that allows you or your doctor to turn the device on or off, and regulate certain settings.
Spinal cord stimulation devices without a rechargeable battery require surgical replacement every few years, depending on the make and model. Rechargeable systems can last up to a decade depending on the model, but must be recharged often (daily, in fact). Be sure to discuss your options with a doctor and weigh the pros and cons together.
When Is SCS Used?
While anyone with chronic pain can request spinal cord stimulation, both insurance companies and most doctors have a list of considerations before going through with the procedure. For the most part, spinal cord stimulation is a treatment utilized only when other, more conservative therapies have clearly failed. Pain management often begins with RICE, unless immediate intervention is necessary. Doctors usually prefer to start with non-opioid medication and non-invasive treatments, avoiding the risks associated with opioid painkillers and surgery.
Alternatively, spinal cord stimulation also becomes an option if you 1.) do not wish to continue doing surgeries to try and fix potential nerve damage/another source of chronic pain, or 2.) surgery is unlikely to improve your condition any further.
Spinal cord stimulation is used to help treat chronic pain in the leg (sciatica), arm, and back. It can also be effective in the treatment of complex regional pain, arachnoiditis, stump pain, angina, multiple sclerosis, failed back surgery syndrome, spinal cord injuries, and more.
If you do not have any medical conditions that prevent you from receiving a pulse device, and if you do not suffer from addiction or depression (both of which should be treated before spinal cord stimulation), you can opt for a spinal cord stimulation trial. The trial is meant to determine whether spinal cord stimulation is worth it in the long-term, or whether it is an ineffective treatment as well.
Preparing for the Procedure
The first step before utilizing spinal cord stimulation as a long-term treatment option is the trial treatment. A doctor will apply a local anesthetic and feed a hollow needle into the epidural space of your spine, between the bone and the cord itself. Utilizing an x-ray for guidance, the doctor will feed a trial lead over specific nerves in the spinal cord, attached to a pulse device worn on a belt (rather than implanted).
With instructions on how to regulate the settings on the device and keep the incision site clean and healthy, you are then tasked to go home and keep a record of your levels of pain, changes in settings, and how certain activities affect your pain with the device on different settings.
Trial periods may last a few days, up to about a week. If the trial was deemed successful, you’re ready for the next step. Before surgery, a doctor will check once more to ensure that you pass all pre-surgical tests. It’s critical that you inform your healthcare professionals of every treatment and medication you’re on and stop taking certain drugs prior to surgery as per their instructions.
The process itself takes anywhere from 1 to 2 hours, and involves to incisions made above the spine, and above the buttock, right where your hip is. The doctor begins with light sedation and an anesthetic on the first incision, to insert the lead into the epidural space and attach several electrodes to various spots on the spinal cord.
What SCS Treatment Can & Cannot Do
Spinal cord stimulation can numb and even override certain pain, especially in the back and limbs. But it does not work the same way for everyone, and while one patient may experience major relief, another may not. This is why the trial period is critical.
When effective, however, spinal cord stimulation can help many people get back the life they’ve been struggling to live for a long time.