Nothing worthwhile comes without some degree of discomfort. But for people with chronic back pain, there is no benefit.
Unfortunately, many people's ability to take pleasure in life is curtailed by chronic back pain. When you're in pain, it's tough to put your mind on anything else. If this describes you, a neurostimulator may be the answer detailed in the ultimate guide to spinal cord stimulation.
Struggling and paying for back pain is a real problem. Adults frequently see doctors because of persistent back discomfort. About 16 million Americans, or about 8% of the population, suffer from persistent or chronic back pain. In the United States, back pain and its sequelae are a common reason for missed work.
In the same study, healthcare spending in 2008 was 2.5 times greater among those with back pain compared to those without the condition. Also, compared to individuals who don't suffer from back pain, those who do often report feeling down and depressed.
Therefore, investigations and research are being conducted on novel therapies for persistent back pain. Spinal cord stimulators (SCS) are often employed as a last resort after less invasive pain management strategies have been unsuccessful.
Spinal cord stimulation (SCS) is a neuromodulation treatment used to treat chronic pain that has a sympathetic component or is caused by nerve damage. Electrodes are placed in the epidural space using either a percutaneous or surgical procedure, and electricity is provided by a battery placed under the skin.
In recent years, spinal cord stimulation has risen in popularity as a therapeutic option for many back-related pains and illnesses. Spinal cord stimulation, also known as neurostimulation, is a technique that uses electrical pulses to disrupt pain impulses traveling down the spinal nerves on their way to the brain.
A tiny electronic implant placed in the lower back or abdomen accomplishes this. Since this device, similar to a modern cardiac pacemaker and sends electronic signals to the affected area at regular intervals, has been dubbed a "pacemaker for pain," the term has caught on with some people.
Those who meet the criteria for this treatment undergo a trial using a similar but distinct piece of machinery. Before implanting the device, the doctor can better assess the patient's pain levels with this information.
Our in-house testing will determine which patients are good candidates for spinal cord stimulation. Collecting a patient's medical background and the current state is the first step in our qualified specialists' comprehensive evaluation.
Those with persistent back pain will get the most from the therapy because it is specifically designed to alleviate that type of discomfort. The number of conditions that can be helped by spinal cord stimulation is vast.
If you or someone you know is experiencing any of the following conditions, please contact us as soon as possible to arrange an examination.
In some cases, the root of the pain may be obvious, while in others, it may take some detective work to pin down. The evaluation process must begin with a thorough history of the pain and a physical examination.
Most of the major causes of chronic pain may be discovered by combining this with laboratory tests, imaging exams, and certain minor treatments. Finding the source of the pain and understanding how and why the injury occurred are crucial steps in developing an effective treatment plan.
The origin of the pain and the nature of the damage are factors that must be considered while determining the best course of treatment for a patient. The origin of the pain might be localized or systemic.
Treatment is most effective when it targets the underlying source of the nerve damage and works to either reverse or ameliorate the damage. Since no one therapy modality has been shown to be effective for all patients, many will require a combination of methods.
The examination and management of chronic pain should often begin with non-surgical methods. Improving lifestyle aspects, including weight control, regular physical exercise, mental and emotional health, diet, and sleep patterns, might aid in rehabilitation.
Many of the previously described bad outcomes are exacerbated by the presence of chronic pain, making it more challenging to maintain a healthy lifestyle. The first line of defense against pain is frequent physical therapy.
Unlike the use of medicine or surgical intervention, this has been shown to increase the prevalence of many of the positive lifestyle characteristics already mentioned.
In order to alleviate pain, there are a number of drugs on the market. Ibuprofen and similar anti-inflammatory medications are frequently used first. Painkillers, such as the opioid oxycodone, are sometimes prescribed by doctors to treat severe pain.
These drugs work well for relieving sudden pain but have a diminished impact on persistent discomfort. Moreover, many prescribed pain relievers are prone to overuse, addiction, and even injury.
The chances of these issues arising with prolonged use of the drugs. It's crucial to discuss any drugs with your doctor first since some may be more appropriate than others for your condition.
It is possible to reduce chronic pain through a variety of methods. A combination of diagnostic and therapeutic treatments will be utilized to determine the source and location of the discomfort.
Injections of numbing medicine and/or steroid medicines to restrict inflammation to a specific location are typical throughout this phase. Procedures like this allow pain doctors to treat patients without resorting to more invasive measures.
Physical ailments can often be remedied by surgical intervention. Surgeons employ imaging techniques, including x-rays, CT scans, and MRI, to investigate the source of discomfort. The best course of action is typically surgical correction when a condition can be diagnosed in this way.
Removal of vertebral bone or fusion of spinal segments is a common procedure in neurosurgery. If the patient's suffering cannot be explained by a flaw or if the defect's correction is unlikely to alleviate the patient's pain, surgical correction is not recommended.
When the source of chronic pain cannot be eliminated, or the injury cannot be cured, a relatively new technology called spinal cord stimulation (SCS) can be used to alleviate the pain. The apparatus is made up of an electrically stimulating wire (or "electrode") that is linked to a control unit (or "generator").
If a stimulating electrode is placed across the spinal cord, the nerve impulse carrying the pain signal cannot go from the spine to the brain. Spinal cord stimulation is explored when a patient has been examined, and non-surgical therapies have been tried for chronic pain management.
Patients who are getting an implanted device usually receive psychological evaluations and counseling sessions to help them prepare for the experience. Experiments involve inserting one or two wires into the spinal canal and manipulating them from an external device.
The patient can evaluate the effectiveness of the wire's stimulation in relieving their pain by leaving it in place for a week. The electrical pulse used for stimulation is so weak that most patients report feeling nothing at all.
These electrical pulses can be modified over the duration of the trial to maximize pain relief. At least 50% pain relief in test subjects is deemed a success.
If the trial goes well, surgery on the implant and a permanent stimulator will be scheduled. A tiny incision is made in the back, and sometimes another one is made at or around the waist. By making a tiny incision in the back, a flat electrode or wire can be inserted into the area behind the spinal cord.
A tiny battery-powered generator is attached to the wire once it has been tunneled under the skin from the incision around the waist. At the incision made at the patient's waist, the generator is inserted subcutaneously. The wounds are closed, and the procedure is complete if the system tests out.
A portable remote allows for easy and precise manipulation of the stimulator's settings. It's important to remember that the batteries in certain generators need to be charged every few days, while others' batteries can go weeks without being touched. Rechargeable batteries may endure for more than ten years, but standard batteries need to be changed every three to five years.
Successful applicants will go through a trial period before the real surgery begins. Rather than surgically implanting the electronic device, this method involves inserting wires into the patient that are then connected to a separate machine. The treatment itself is quite similar to standard therapy; it lasts for five to seven days, and pain and pain levels are monitored the entire time.
When the test is ready to begin, the patient will have wires taped to their body and connected to a portable electronic monitor that will be worn on the patient's belt. The patient will wear this belt and use the controller to customize the intensity of the electrical stimulation (which is usually programmed based on the earlier feedback between the two).
Before being discharged, the patient will be observed for a brief time and given rest instructions. The patient should keep track of their experiences with the stimulation during the trial time.
The surgeon has to know about your medical history (allergies, medications/vitamins, bleeding history, anesthetic responses, and past operations), so you'll sign a consent form and other paperwork in the doctor's office.
Always be honest with your doctor about any and all drugs you're taking, whether they're prescribed, OTC, or herbal. Some preoperative tests (such as a blood draw, EKG, and chest X-ray) may be required many days before surgery. Before deciding to stop taking any drugs, you should discuss doing so with your primary care doctor and get the all-clear for surgery.
Your surgeon has instructed you to continue taking these drugs. It is recommended that patients discontinue the use of blood thinners such as Coumadin, aspirin, Plavix, and similar medications seven days prior to surgery.
The use of tobacco products and alcoholic beverages should be discontinued one week before surgery and for two weeks thereafter in order to prevent bleeding and healing complications.
Before going under the knife, you could be requested to give your skin a good washing with Hibiclens (CHG) or Dial soap. As a result, it eliminates microorganisms and lessens the risk of infection at the surgery site. (Chloroform should not be used near the eyes, ears, nose, or genitalia.)
Morning of surgery
Go to the hospital. Arrive at the outpatient surgery facility 2 hours before your operation appointment (1 hour earlier if you need to fill out paperwork) to ensure you have plenty of time to finish all the essential pre-procedure tasks.
An anesthesiologist will consult with you and go over the potential outcomes and side effects of receiving anesthesia. You'll have an IV line inserted into your arm.
Although the trial approach is comparable to real neurostimulation, there are several important changes. The actual generator is implanted, which is a key difference.
Two to three weeks of rest and rehabilitation are often required for patients to return to their pre-surgery routines. Complete recuperation may take up to eight weeks, and you should avoid strenuous exercise for about three months to keep the permanent leads from moving.
Your next conscious moment will be in the recovery area. We will check your pulse, respiration rate, and blood pressure often, and we will treat your pain as well. The vast majority of people are sent home from the hospital the following day or the day after.
Before you depart, the pulse generator will be set up with the appropriate parameters. At the end of the day, you will have written instructions to follow.
If your doctor hasn't scheduled a follow-up appointment for you within two weeks after surgery, it's important to take care of yourself as instructed during this time. What you can probably count on in most cases is the following:
Surgery Post-Op Care
When to See a Physician
Symptoms of an infected surgical incision.
Due to the abundance of nerves in the spine, effective treatment of persistent back and/or neck pain can be difficult to achieve. Since this is the case, spinal cord stimulation has become a popular treatment option. Spinal cord stimulation has been shown to be effective in studies for treating chronic pain, especially in patients who have tried and failed conventional treatments.
Although rare, spinal cord stimulation can cause a number of unwanted side effects due to the invasive nature of the operation.
Opioids may be explored for postoperative pain management for up to four weeks; however, due to their addictive nature and potential adverse effects, their usage should be limited if at all feasible. It is helpful for a doctor to know what kind of swelling a patient has experienced from a family member or acquaintance.
Some patients have reported difficulties related to the device itself, in addition to those experienced after surgery. Leads moving, breaking, or not connecting properly within the body post-surgery are the most common causes of these issues.
These problems were more widespread in the past, but because of technological advancements, they have become far less common in recent years. Rare incidences of epidural bleeding, nerve root or spinal cord injury, and infections have been reported.
When low back pain persists for more than 12 weeks, doctors label it chronic. Twenty percent of people who have acute back pain report that it persists long-term. Doctors evaluate a patient's mobility (by having them walk, sit, and stand) to pinpoint the source of their persistent back pain. Additionally, medical professionals will inquire as to how patients are managing their pain on a scale from zero to 10.
These evaluations are essential for deciding how to treat the pain, eliminating possible causes, and locating its origin. Common diagnostic procedures include radiological examinations (such as x-rays, MRIs, or CT scans), laboratory analyses of blood and nerve samples, and physical examinations.
If you're experiencing any of the following symptoms together with back pain, you must immediately consult a doctor.
There might be a number of different causes of pain for a given individual. When you're in pain all the time, it might be because of your job, an injury, a physical limitation, or even your mental state. Some of the potential causes of chronic back pain are discussed here.
Back pain can be worse by habits like not getting enough exercise or smoking. When people are less active, their back muscles become tight and weak.
More rigidity in the back increases the risk of pain when moving. Pain makes people less likely to exercise, which makes the problem even worse.
Some people are more likely to have back pain if they suffer from psychological disorders like depression or anxiety. Muscle tension, headaches, and general aches and pains can all contribute to back pain in persons with anxiety disorders.
It requires work and time to treat chronic pain. Those suffering from chronic pain will do almost everything to alleviate their suffering. This is why a lot of research and development time, and money is being poured into finding and creating new treatments and medications.
However, these advances aren't always accessible to the general public. Some people benefit more than others with spinal cord stimulators, for instance.
Among the potential methods for alleviating chronic back pain are the following:
Along with physical therapy, there are other non-invasive methods for relieving back pain. Physical therapists have a wide variety of passive treatments at their disposal, including the use of heat or cold, transcutaneous electrical nerve stimulation (TENS), iontophoresis, and ultrasound.
In order for an active operation to have an effect on the body, a passive procedure must have been performed.
Active methods could involve a variety of therapeutic exercises to improve strength, flexibility, and range of motion to prevent future neck and shoulder pain, as well as back pain. These techniques are often helpful for those who have disuse atrophy (muscle wasting due to inactivity), nerve irritation, or muscular issues owing to bad posture.
Dynamic core workouts, such as abdominal crunches and leg lifts, build a muscular corset that supports the spine. It's disappointing when your efforts to be in shape don't pay off physically.
This is why it's possible that physical therapy won't help your back pain.
This style of meditation alters one's capacity to pay attention to what is happening in the present moment, whether it be one's thoughts, emotions, or bodily sensations.
Practitioners of mindfulness meditation learn to appreciate everything the present moment has to offer, even the pain they may be feeling. Unease contributes to these responses and concepts. Understanding one's own internal emotional environment can improve response to treatment and overall management of chronic pain.
Some guidelines for practicing mindfulness meditation are provided below.
Anti-inflammatory foods include fruits, vegetables, lean protein, and healthy fats, and they can be used to treat pain. There are several fruits that can help reduce inflammation, such as strawberries, blueberries, oranges, and cherries. Consuming lean proteins like chicken and fish might also aid in the fight against edema.
The painkilling effects of nuts like almonds and walnuts have been well-documented. Studies have linked the consumption of chlorophyll-rich vegetables, including broccoli, kale, Brussels sprouts, asparagus, and spinach, to the attenuation and eventual resolution of inflammatory reactions in the human body.
One of the best methods to avoid back pain and other discomforts that could necessitate invasive treatment is to work on one's posture.
Incorrect posture may be to blame for your persistent back pain. People may not realize they have bad posture if they are too preoccupied with their task or if they have formed the habit of slouching over time.
They recommend getting up and moving around every 30 minutes. Likewise, if you sit at the very end of the chair, your back will receive the most support.
Multiple therapeutic injections exist for relieving back pain and other symptoms. Injections into the epidural space, joints, and nerve roots are all good examples of this.
Various drugs, including opioids, nonopioid painkillers, narcotics, muscle relaxants, and antidepressants, are prescribed by doctors to treat persistent back pain.
Pain relievers like acetaminophen and nonsteroidal anti-inflammatory medicines (NSAIDs) are examples of pharmaceuticals that do not fall into the opioid category. Nonsteroidal anti-inflammatory drugs (NSAIDs) include ibuprofen, diclofenac, naproxen, mefenamic acid, and indomethacin. It's important to be cautious when using NSAIDS because they might cause lightheadedness, stomach discomfort, hypertension, and nausea.
When dealing with severe pain, doctors often recommend opioids or narcotics. Doctors often administer drugs for no longer than a week at a time due to the high risk of physical dependence. Codeine, fentanyl, hydrocodone, meperidine, tramadol, and morphine are all opioid pain relievers.
Various alternative and complementary medicine treatments, such as acupuncture, yoga, and massage, have been shown to be effective in treating persistent back pain.
Spinal cord stimulators are one of the most promising non-surgical therapies for chronic back pain. There are three primary variants of the SCS:
When all other options have been exhausted, surgical intervention may be suggested. When persistent back pain is accompanied by a weakened feeling in the limbs or rapid reflexes, surgery may be necessary (quicker than average response).
Dangerous side effects of these reflexes include dizziness, fainting, sweating, constriction of peripheral blood vessels, and a sluggish heart rate.
Problems with urination, defecation, or both are further indicators that surgical intervention is warranted.
With the exception of refractory angina pectoris and cancer-related pain, all other uses of SCS are still in the experimental/investigative stages. There is not enough proof that SCS has positive after-effects on health.
Proper patient selection for spinal cord stimulator implantation is essential for the therapeutic efficacy of this modality. Payment for the spinal cord (dorsal column) stimulator implantation or services and supplies linked to such implantation is not permitted until all of the following requirements have been met:
Temporary spinal cord stimulator trials are limited to two per anatomic spinal region (two per DOS) or (four units) per patient over the course of their lifetime, regardless of whether the procedure was performed in a doctor's office, ambulatory surgical center, outpatient hospital, or inpatient hospital.
Percutaneous implantation of the neurostimulator electrode array, epidural can be covered more regularly in lieu of service ASC, outpatient hospital, or hospital since permanent neurostimulator arrays can also be inserted percutaneously.
One permanent spinal cord stimulator can be implanted through laminectomy in an ambulatory surgical center (ASC), outpatient hospital (OH), or hospital for a patient's lifetime.
Due to their inclusion in Percutaneous Implantation of Neurostimulator Electrode Array, Epidural, removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed, and revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed, are not reimbursable in the office setting.
If a trial ends in failure, it is not suitable to try again absent exceptional conditions. When performed more frequently than once every 30 days, computerized analysis is typically not regarded as medically required. During the first month following implantation, more regular testing may be required.
Please call us to consult with one of our pain management professionals, who can help you decide if a neurostimulator implant is the best course of treatment for your condition.
Don't wait any longer to make an appointment with Atlas Pain Specialists. Your call is greatly anticipated.
Chronic pain can have a negative impact on a person's quality of life. A trip to the doctor is warranted if the pain is severe, persists after a few days of rest, and is still disruptive to daily living.
Early examinations of chronic pain are best handled by primary care providers. It is recommended to see a pain specialist if your symptoms have continued for more than six months.
To reduce the sensation of pain, a spinal cord stimulator (SCS) is implanted subcutaneously and emits a little electrical current.
Thin wires or electrodes are implanted in the epidural space, which is the area between the skull and the spinal cord, to create spinal cord stimulation. An SCS generator, similar to a pacemaker's battery pack, is also implanted beneath the skin.
Pain relief is the primary advantage of spinal cord stimulators. In addition to these improvements in functioning, the SCS also allows for less reliance on bracing, decreased usage of pain medicines, decreased reliance on narcotics or opioids, and enhanced activity and mobility.
In most cases, patients who use a spinal cord stimulator can safely undergo imaging procedures like X-rays and CT scans as long as they disable their device. In any case, patients should double-check with their doctors to see if certain MRI equipment is compatible with their neurostimulator implants. If you don't, getting an MRI evaluation might seriously harm you.
Medical imaging and psychological evaluations help doctors determine whether or not spinal cord stimulation (SCS) is a good option for a patient. Those who have tried medication, prior surgical procedures, or less invasive therapies for pain management and found them wanting are also candidates.
Furthermore, SCS is suggested for those without psychiatric disorders, as certain conditions would reduce the efficiency of the neurostimulator device.
Many kinds of pain, including chronic back pain, may respond to treatment using a spinal neurostimulator. Surgery for botched back surgery syndrome or postoperative pain is one possible source of this discomfort.
There is always a chance of something going wrong with a medical procedure. Infection after implantation, epidural hematoma or fibrosis, dural puncture, discomfort, allergy to the device, and neurologic damage are all possible complications.
A preliminary step is a trial run using SCS. The surgeon will put in a temporary device. The electrodes will be placed in the epidural space of the spine by a single incision under fluoroscopy guidance. The power plant will be mounted away from the human frame. The surgeon will frequently check in for updates during the operation.
The surgeon will determine in a week if the gadget is effective in reducing discomfort. This non-surgical therapy must be effective in managing pain for at least 50% before it may be permanently implanted. Without risking injury to the spinal cord or nerves, the wires will be withdrawn if the procedure is unsuccessful.
It might take between 1 and 2 hours to complete the operation as an outpatient.
Two small incisions will be made under local anesthetic so the surgeon may (1) install permanent electrodes and (2) hold the generator. After that, the power source is surgically implanted beneath the surface of the patient's skin.
Sutures, checked with fluoroscopy, will secure sterile electrodes. The doctor will keep close tabs on the patient's health while the surgery progresses. Once the generator is hooked up to the electrodes and working, the surgeon will seal the wounds.
The surgeon will make two cuts in the skin. The doctor inserts the leads through tiny cuts that are about two to four inches long.
The use of general anesthesia is common. Ligaments and bone in the spine are sutured together before electrodes are attached. The patient will have an incision made in the area of their lower back, just above where their buttocks are.
Tiny pulses of moderate electric current will be sent through leads implanted in the body to particular nerves. The nerve endings' ability to send pain signals to the brain is blocked by the electric current.
The stimulation may be turned on and off with remote control. In most cases, a doctor will recommend between two and three individual adjustments. Just keep in mind that a spinal cord stimulator will merely dull the ache; the spine itself will remain unchanged.
Patients are free to depart once the effects of the anesthetic have worn off, as this is an outpatient operation. Stretching, reaching, or twisting might cause further pain to the surgeon as they close wounds. After three days, the incisions can have the dressings removed. Surgery incisions typically heal within two to four weeks.
The effectiveness of spinal cord stimulators has been reported by patients in recent research. This research shows that after four years of use, spinal neurostimulator implants continue to be beneficial.
In only a few short weeks, you should feel complete back to normal after this little operation. In two to three weeks, patients can return to light work. A patient should not ascend or descend more than two flights of stairs in the first week. In the first two weeks following surgery, patients are instructed to avoid driving or riding in a car and are forbidden to lift objects weighing more than two liters.
Which potentially fatal side effects do neurostimulators have?
In most cases, putting in a neurostimulator device is completely risk-free. On the other hand, there is always some danger involved in every process. Infection, hemorrhage, device damage, electrode movement, dural puncture (look out for cerebrospinal fluid leaks), and spinal cord injuries are all potential complications for certain individuals.
When I get back to having sex after my SCS procedure, when can I start?
When people are ready, they can get back to their normal routines, whether that's sexual activity or exercise. In the first two weeks following the surgery, you should refrain from any intense activity, including lifting.
Will My Neurostimulator Implant Affect My Ability To Swim Or Drive?
To avoid any distractions while driving, disable the neurostimulator implant. This precaution is used to forestall disruptions brought on by unexpected changes in the environment.
A permanent implant of a generator allows people to swim. Even in the shower or bath, people shouldn't submerge the stimulator in water if it's only a trial version.
If I get a neurostimulator implant, how long will it last?
Depending on the patient's condition and the technology in use, the average lifespan of a spinal cord stimulator battery is nine years. We find even little aches and pains to be annoying.
Most patients who look into getting a spinal cord stimulator have reached a point when their pain is severely interfering with their everyday lives. Given the individual nature of pain, each treatment plan for managing it should be tailored to that patient's specific needs. After all, alleviating suffering is an essential first step in enhancing the quality of life.
Who is responsible for carrying out the operation?
Spinal cord stimulators are implanted by neurosurgeons and pain management experts (anesthesiologists and physiatrists).