Pain Management Technique: Patient Controls Spinal Cord Stimulation

Question: My doctor just suggested spinal cord stimulation, so your last answer was very timely. But I still have one main question: How do I keep it from “over-stimulating”? I'm very concerned about the safety of spinal cord stimulation.
—Durham, NC

illustration of brain with spinal cordAnswer: Before you have a spinal cord stimulator (SCS) implanted—and even before you have a trial run with the spinal cord stimulator—please ask your doctor any and all questions. He should take the time to thoroughly explain how the stimulator works, what precautions you'll have to take, and the risks and benefits.

I'm glad you wrote in to Ask the Experts, too, though. It's worthwhile to gather as much information as you can, so I hope my information helps you make a decision.

With a spinal cord stimulator, patients are well-educated about how to use the system. You have a programmer that will turn it off and on, so you're in charge. The control aspect is one of the best benefits of spinal cord stimulation. You decide when you need pain relief for your back pain, and you choose to turn on the stimulator.

The programmer is a magnetic remote control, a very simple device. Your doctor will show you how to swipe it over the implanted generator to turn the stimulator on and off.

You also determine how much pain relief you need. The initial programming is done at your doctor's office, but during that time, you should also learn how to control the intensity of the stimulation. It will, however, be programmed so that it can't exceed a set level; that should assuage your fear about over-stimulation.

There is a minimal risk of over-stimulation with SCS, but you won't actually harm yourself by over-stimulating. Instead, it's more of a discomfort issue, and that will resolve either by adjusting the frequency or the amplitude.

It is rare that a patient cannot tolerate stimulation, and these cases are discovered during the trial period. (You can read my previous answer for more details about the spinal cord stimulation trial period ).

With a spinal cord stimulator, you do have a few extra precautions to take, and I want you to be aware of these as you consider SCS:

  • You can't have an MRI, but you can have a CT scan or an ultrasound.
  • Depending on your doctor's guidelines and restrictions, you may not be able to drive while your SCS is on. I allow my patients to drive with the stimulator on, once they are used to it. I usually have them set the unit at a lower amplitude. However, your doctor may recommend that you don't drive; that decision is very dependent on your case. Even with the SCS on, you can always ride as a passenger in a car.
  • SCS has essentially the same precautions as a pacemaker. As with a pacemaker, you'll be given a card that proves you have an SCS implant. That'll help you at airport security checkpoints because the SCS can set off the alarm in metal detectors.

Keep this in mind, too: If the spinal cord stimulator doesn't work as well as you'd like it to, you can always have it removed. It's a completely reversible procedure.

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