Spinal Cord Stimulation

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October 03, 2012
Edward Smith

Spinal cord stimulation is used to manage chronic pain. Doctors implant a pulse generator that delivers an electrical pulse to the spinal cord. The electricity impairs the function of the nerve signals sent by the painful area to the pain.

Spinal cord stimulators are implanted in the back using sedation and local anesthesia. A trial run is done first using a small, temporary pulse generator. This type of percutaneous stimulator is a temporary pain-relieving device because it tends to migrate under the skin. If it works, however, a permanent spinal cord stimulator is implanted under the abdominal skin with wires passed around to the back and inserted in the spinal cord. This stimulator is considered more stable and can be used for years.
When a spinal cord stimulator is in place, the painful area feels tingly instead of painful. After the stimulator is put in place, it’s necessary to keep the small incision dry and sanitary so it doesn’t get infected.

Who gets spinal cord stimulation surgery? It is usually done for those people who have had back surgery that failed to relive their pain or for people who have had neurological pain or numbness. People with complex and chronic pain conditions like complex regional pain syndrome or reflex sympathetic dystrophy are also good candidates for spinal cord stimulation. It has been used in investigational studies for people with multiple sclerosis, intractable angina or paraplegia but is not in common use.

Stimulation of the spinal cord does not work in all cases. It can be helpful in situations where back surgery failed and in reflex sympathetic dystrophy or complex regional pain syndrome. Some cases of chronic, unremitting low back pain get better with spinal cord stimulation.

Research reveals that, in a majority of the people treated with spinal cord stimulation in cases of leg pain, ischemia of the leg due to peripheral arterial disease and chronic low back pain, there is relief of the pain using this technique. People with low back pain that does not go away also have relief of pain about half of the time.

One problem with this technique is that many people get pain relief in the beginning but have a gradual loss of pain relief due to the spinal cord becoming tolerant to the therapy.
There are risks to be concerned with when undergoing spinal cord stimulation. One can get scar tissue formation where the electrode is inserted into the spinal cord. There can be pain that moves up past the level of the stimulation and a hardware failure or breakage of the electrode. In addition, infection can occur after the surgery and the spinal cord fluid can leak around the electrode causing a spinal headache. Problems urinating are possible and tolerance can render the therapy useless. If a person has a stimulator implanted, they are unable to have an MRI examination.

The proof that spinal cord stimulation actually works is limited; clearly, more and better research is needed. The treatment appears to be related to the actual cause of the pain. The batteries, incidentally, need to be changed every 2-5 years and this requires an additional surgery.