Spinal Cord Stimulation May Offer Pain Relief When Nonsurgical Options Fail

For people with longstanding back pain, who haven’t been able to find relief with medications or surgery, spinal cord stimulation may be an option. 

A spinal cord stimulator is an implanted device that sends low levels of electricity directly into the spinal cord to relieve pain. They are classically used for people with chronic sciatica that didn’t respond to surgery or repeated injections or those who have had back surgery but have not gotten relief from pain. The stimulator can also be used for people who have neck or arm pain, but it’s mostly used for chronic back issues. 

A spinal cord stimulator consists of thin wires, electrodes, and a small battery pack, which is placed under the skin near the buttocks or abdomen. Electrodes are placed between the spinal cord and vertebrae. We register pain after it goes through the spinal cord to the brain. The stimulator uses the wires and impulses on the spinal cord to interrupt the pain signal. This works on the chemistry by using electrical energy rather than chemicals which is appealing as a non-drug therapy to help decrease pain. 

I often describe this as influencing the traffic in your spine.  The stimulator allows you to go right to the highway or the hub of information, bypassing the dirt roads or tributaries.

The process of having a spinal cord stimulator implanted involves two parts and begins with a trial. This is done with conscious sedation, which keeps you comfortable and reduces anxiety. It is like an epidural or steroid injection. We use a specific type of X-ray called fluoroscopy to see as we thread a thin wire through a needle and into the epidural space just behind the thoracic spinal cord. The location of each patient’s individual pain affects where these electrodes will be placed along the spine. 

Once the test wires are placed, we test the electrical current while you are on the table to see if the current is covering the area of pain. We make minor adjustments to make sure the stimulation is felt in the correct area. It will be like a buzzing of tingling sensation. After everything is placed correctly, we tape and secure the end of the battery, which is worn on the waistline. 

You are typically sent home for about a week, during which you’re asked to limit certain movements and keep a journal of how your pain differs during everyday activities. At the end of the week, it’s a simple procedure to remove the temporary wire. You need to experience 50 percent pain relief to move ahead with a permanent stimulator. Some people describe this as a light switched on as soon as the device is implanted. 

The procedure to install the permanent implant takes about one hour and is done in an outpatient setting. We begin by administering local anesthesia, before your surgeon makes two incisions, one along your lower abdomen or buttocks to hold the generator, and a second, along your spine, to insert the permanent electrodes. Your surgeon will typically use images from the trial to decide where the permanent wires should be placed.

Most people feel better in a day or two after the permanent stimulator has been implanted. You can proceed with activities, but cautiously, because we don’t want anything to shift for the first six weeks after the implantation. This means actions like bending forward, touching toes, or reaching too high, should be limited to avoid too much range of motion in the spine. 

There is a remote control that can be used to adjust the level of electrical stimulation and every patient is paired with a device specialist through the manufacturer, who helps them set the remote control up for their individual pain level and lifestyle. This may involve increasing or decreasing the intensity of the electrical signal. The system can stay in for life, but most have a battery life, and the battery will need to be replaced at some point. That can be done with a relatively simple procedure that requires only a minor incision, again in an outpatient setting. 

The important thing to remember with this is that for the majority of people, this is not a first line treatment. There’s a process to go through, with other treatment options to consider, before deciding if you’re a candidate for a spinal stimulator. Before proceeding, you need to sit down and have an honest conversation about what you’ve done so far and once you’ve exhausted the most reasonable options, talk with your doctor about whether this might be an option. 

Richard Feeney, DO is a Physiatrist in Exeter, New Hampshire. Dr. Feeney is board certified in Physical Medicine and Rehabilitation (Physiatry) and Pain Medicine.