Spinal Cord Stimulation
What is Spinal Cord Stimulation?
It is a therapy that uses electrical impulses to block pain from being perceived in the brain. Instead of pain, the patient feels a more pleasant tingling sensation.
Who is a good candidate for a Spinal Cord Stimulator?
Conservative treatments have been tried and failed. Treatment is most effective when pain is in one or both arms or legs, or for low back pain that persists after surgery. Further surgery is not likely to help. The patient has no untreated drug addictions. The patient has had a psychological evaluation.The patient has had a successful SCS trial. The patient is willing to play an active role in establishing and maintaining increased quality of life. After you and your physician discuss the SCS and determine that you would like to proceed, a trial will be arranged to learn if this treatment modality would be effective in treating your pain. The trial involves placement of temporary stimulator leads into your spinal canal to determine if the area of your pain will be covered by stimulation. The trial may last a minimum or 24 hours or as long as several weeks. You will want to be certain that you have satisfactory pain control and that you are comfortable with the sensations of stimulation. If the trial is successful, the permanent stimulator implantation may be scheduled. Expect that sneezing, coughing or even laughing can make the stimulation more intense as this may cause the lead to have closer contact with the spinal column.
What happens in the procedure?
The procedure will take place in a sterile environment or in the operating room. You will be given a local anesthetic so that you can be awake during the procedure (with minimal discomfort) in order to give feedback to the physician regarding effective lead placement. After the local anesthetic has time to numb the area where the lead will be placed, the lead is inserted near your spinal cord through a needle or through an incision. Once the lead is in place, your physician will activate the system. You will help the physician determine how well the stimulation pattern covers your pain pattern. You will also get a sense of how stimulation feels to help determine if it is right for you.
What happens after the procedure?
As with any surgery, you will have some discomfort at the incision sites, and there will be some swelling which usually lasts for several days. There will be some discomfort over the area where the receiver is implanted. This is normal. Your doctor may prescribe an analgesic until this subsides. Immediately following implantation, you should avoid lifting, bending, stretching, over head reaching and twisting. Light exercise, such as walking is important to build strength and to help relieve pain. It usually takes 6 weeks for your leads to scar down. Thus, sneezing, coughing, and laughing can still intensify the stimulation. Leads can remain permanently in place.
However, if you engage in extreme bending, stretching, twisting, or strenuous activity such as jumping exercises and diving, etc., the leads may move or become damaged and require surgical repositioning or removal. Moving or lifting heavy objects can move or break the leads. Sometimes leads will move as a result of normal bending, stretching, or twisting, or due to your unique physical structure. Check with your doctor before performing any strenuous activity. Do not drive a motor vehicle or heavy equipment while using the stimulator. You may use it if you are a passenger.
The stimulator will set off metal detectors (such as at airports), you will want to be sure you have your SCS identification card in order to pass through. Department store theft detectors may cause an increase or decrease in stimulation as you pass through, this is temporary and will not harm you or the stimulator, however, you may wish to turn the stimulator off before passing through. Anything with magnets can affect your stimulator, in addition to theft detectors and metal detectors, be mindful of large stereo speakers with magnets, high voltage power lines, electric arc welding equipment, electric sub-stations and power generators.
Magnets can turn an internally powered generator on or off. Avoid MRIs as they can damage the stimulator. Normal household equipment will not harm or interfere with the stimulator, this includes cellular or portable phones, microwaves, computers, TVs, appliances, electric blankets, and heating pads. Report to your doctor's nurse changes in stimulation patterns, increase in pain, or unexplained increased / decreased stimulation.
Will I be pain free?
There will be residual discomfort, most patients report that 50%- 70% decrease in pain. The goal is to lower the level of pain and make it more manageable.
How will a spinal cord stimulator help me?
Depending upon your work, you should be able to resume work at home or job that does not require strenuous physical activity. You can resume sexual activity. You can travel, keeping in mind that sitting for long periods of time is best avoided. You will be able to participate in recreational activities such as walking, fishing, and gardening. You will feel more in control of your attitude, and should notice a positive effect upon relationships.
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