Spinal cord stimulation for chronic pain
Spinal cord stimulation (SCS) is a procedure
that uses an electrical current to treat
chronic pain. A small pulse generator, implanted in
the back, sends electrical pulses to the spinal cord. These pulses interfere
with the nerve impulses that make you feel pain.
Implanting the
stimulator is typically done using a
local anesthetic and a
sedative. Your doctor usually will first insert a
trial stimulator through the skin (percutaneously) to give the treatment a
trial run. (A percutaneous stimulator tends to move from its original location,
so it is considered temporary.) If the trial is successful, your doctor can
implant a more permanent stimulator. The stimulator itself is implanted under
the skin of the belly (abdomen), and the small coated wires (leads) are
inserted under the skin to the point where they are inserted into the spinal
canal. This placement in the abdomen is a more stable, effective location. Most
stimulator batteries must be replaced every 2 to 5 years.
After
this outpatient procedure is complete, you and your doctor determine the best
pulse strength. You are then told how to use the stimulator at home. A typical
schedule for spinal cord stimulation is to use it for 1 or 2 hours, 3 or 4
times a day.
When in use, the spinal cord stimulator creates a
tingling feeling, rather than the pain you have felt in the past.
You will have a small incision that you
should keep clean and dry until it heals.
This treatment may be done for people
with severe, chronic pain who have:
- Had a failed spinal surgery.
- Severe
nerve-related pain or numbness.
- Chronic pain syndromes, such as
reflex sympathetic dystrophy.
Spinal cord stimulation is typically considered
investigational for various other conditions, including
multiple sclerosis, paraplegia, and intractable
angina.
Some researchers have reported that
more than 60% of people receiving spinal cord stimulation for low back and leg
pain (with or without surgery) have pain reduction or relief.1 But there is still not strong proof that spinal cord
stimulation works.2, 3
Treatment success varies widely, influenced by the cause of pain and, if there
has been a previous back surgery, the amount of time that has passed since the
first surgery on the affected area. The more time that has passed since a first
surgery, the less likely spinal cord stimulation is to overcome the pain
signals that have developed over time.
One long-term study
suggests that conditions that are most likely to have long-term benefit from
spinal cord stimulation are failed back syndrome (pain that spreads or that
continues after surgery),
reflex sympathetic dystrophy,
multiple sclerosis,
peripheral arterial disease, and
peripheral neuropathy.4
Initial pain relief is often followed by a
gradual decline in effectiveness, apparently caused by the body's increasing
tolerance to the treatment.
Possible risks related to spinal cord stimulation
include:
- Scar tissue (fibrosis) developing around the
electrode.
- Pain gradually moving beyond the reach of the nerve
stimulator.
- Breakage of an electrode or hardware failure.
- Infection.
- Leakage of spinal
fluid.
- Headache.
- Bladder problems.
- Getting
used to the stimulation, making it less effective.
Spinal cord stimulation may be
recommended for a small subset of people suffering from certain types of
chronic pain such as pain from a nerve root injury.
Most spinal
cord stimulator batteries must be replaced every 2 to 5 years.
Complete the special treatment information form (PDF)
(What is a PDF document?)
to help you understand this treatment.
Citations
Cameron T (2004). Safety and efficacy of spinal cord
stimulation for the treatment of chronic pain: A 20-year literature review.
Journal of Neurosurgery, 100(3, Suppl Spine):
254–267.
Taylor RS, et al. (2005). Spinal cord stimulation for
chronic back and leg pain and failed back surgery syndrome: A systematic review
and analysis of prognostic factors. Spine, 30(1):
152–160.
Mailis-Gagnon A, et al. (2007). Spinal cord
stimulation for chronic pain. Cochrane Database of Systematic Reviews (2).
Kumar K, et al. (1998). Epidural spinal cord
stimulation for treatment of chronic pain—Some predictors of success. A 15-year
experience. Surgical Neurology, 50(2):
110–121.
| Author | Monica Rhodes |
| Editor | Kathleen M. Ariss, MS |
| Associate Editor | Pat Truman, MATC |
| Primary Medical Reviewer | Anne C. Poinier, MD - Internal Medicine |
| Specialist Medical Reviewer | Nancy Greenwald, MD - Physical Medicine and Rehabilitation |
| Last Updated | January 20, 2009 |
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