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Spinal Cord Stimulation: Advantages and Risks and Who is a Candidate?

Peer Reviewed

Advantages to Stimulation
There are many advantages to spinal cord or peripheral nerve stimulation for the treatment of chronic back pain: 

  • A trial of stimulation can be done first to make sure the patient has a good response to stimulation before the patient commits to a permanent implant. 
  • It is easily reversible; if it doesn't work or is no longer needed it can be removed. 
  • It has few side effects. 
  • Implantation of the system is usually minimally invasive, requiring a minor surgical procedure on an outpatient basis. 
  • Pain relief with SCS can allow patients to reduce or eliminate their use of narcotic drugs. 
  • Developments in programmable systems and patient-controlled devices allow patients to adjust stimulation rapidly in response to changes in the location or severity of their pain. As mentioned above, with current MICC technologies available, the patient can program his or her own system. 
  • Continuous improvements in the design of electrodes and longer lasting, easily rechargeable batteries mean entire implantable systems can be placed. While rechargeable systems by themselves do not provide any better stimulation than systems that require battery changes every 3-4 years, the newer technology (MICC) may give better and more efficient pain control than other types of spinal cord stimulation systems. 
  • The system is completely implanted. Patients can travel anywhere and participate in many nonimpact recreational activities, including swimming.

What Are the Risks of Stimulation?
Like any procedure, there are always potential risks involved. The incident of these risks is low, but may include:

  • Bleeding
  • Infection
  • Weakness, numbness, clumsiness, paralysis
  • Battery failure and/or battery leakage
  • Spinal fluid leak from the spinal canal, causing headache
  • Undesirable changes in stimulation may occur over time because of scar tissue forming around the leads, or movement of the lead position
  • Allergic reaction to implanted materials 

Am I a Candidate for Spinal Cord Stimulation? 

  • If you have chronic back pain, with or without leg pain, and this pain is not due to movement (ie, mechanical pain) 
  • If you have chronic neck pain, with or without arm pain, and this pain is not due to movement (ie, mechanical pain) 
  • If you have had back surgery, but still have pain and this pain is not due to movement (ie, mechanical pain) 
  • If you have peripheral neuropathy 
  • If you have peripheral vascular disease 
  • If you have Reflex Sympathetic Dystrophy (RSD), now known as Complex Regional Pain Syndrome (CRPS) 
  • If you have Refractory Angina (angina that has not responded to stenting, bypass, and/or medications) 
  • If you have chronic post inguinal hernia repair pain " If you have chronic abdominal pain (that is due to abnormal nerve function) 
  • If other treatments have not helped your pain 
  • If you do not have a pacemaker and are not pregnant

How Can I Find Out More about Spinal Cord Stimulation?
Talk to your spine doctor or pain specialist to find out more about neurostimulation with SCS.

Updated on: 09/07/12
Daniel S. Bennett, MD
Electrical neuromodulation (the formal name for pain therapies that 'change' the way the nervous system processes pain) therapies have been around since the late 1960's. Over the last 15 years, the reliability of these therapies has reached 80-85% for nerve injury (also called neuropathic) pain. Examples of neuropathic pain are nerve root injury (such as when a disc compresses and thereby injures a nerve), complex regional pain syndromes (where nerves become 'crazed' leading to fire-like pain in a whole arm or leg), pelvic pain, and even diabetic neuropathy and headache. The way in which this is applied has long been by spinal cord stimulation (where electrodes are placed by the surgeon over the area of the spinal cord). More recently, however, stimulation of nerve roots (where electrodes are placed at a location in the spine that gives rise to a nerve) has been shown to be more effective in some pain states. Use of electrical neuromodulation has also been effective when applied to peripheral nerves (that is nerves that lie outside of the spinal canal or brain). Examples of this include occipital nerve stimulation for headache and stimulation of facial nerves in face pain. When compared to medications (which often carry significant side effects (such as sleepiness and memory loss) which have about a 34% chance of long term success, electrical neuromodulation has no significant side effects, and can be as much as 85% effective long term. Unlike older technology where leads would break and stimulation effects would fade, newer technology in electrical neuromodulation does not have these problems. Once structural ("carpentry") problems are addressed (such as spine fusion, discectomy, etc), it is now possible to address the nerve pain ("electrical"). In the future, we now know that placement of similar electrodes on the surface of the brain (known as motor cortex stimulation) will allow for control of even more complex pain states such as trigeminal neuralgia and stroke pain; this therapy also looks promising when a person's pain cannot be reached by spinal cord, nerve root or peripheral stimulation, with low complication rates. It is truly a remarkable technology, when applied by expert hands that gives hope to many who live with terrible pain.
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