Spinal Cord Stimulation for Chronic Pain: What You Need to Know

Neurosurgeon, Jason M. Highsmith, MD, treats patients using SCS and provides guidance for patients considering spinal cord stimulation.

Spinal cord stimulation (SCS) has become a standard of care for people with chronic back and neck pain. Advances in SCS technology have allowed people with chronic spine-related pain to reduce or eliminate their need for pain medications and return to comfortable, productive lives. To better understand what you need to know before undergoing SCS, SpineUniverse spoke with Jason M. Highsmith, MD.
man holding his back in bed, with a painful expression on his face Q: What spine-related problems are treatable with SCS?
Dr. Highsmith:
SCS is best at treating neuropathic pain from a pinched or injured nerve, and is also good at treating mechanical back pain from such conditions as degenerative disc disease, radiculopathy (pain that radiates down an arm or leg), spinal stenosis (narrowing of the spinal canal), failed back surgery or residual pain following back surgery, and sciatica. In addition, SCS is useful in treating complex regional pain syndrome (CRPS), which is a relatively uncommon form of chronic pain.

SCS does not treat weakness or numbness and is not useful in treating pain from a bone fracture or cancer.

Q: When should a trial of SCS be considered in a person with chronic pain?
Dr. Highsmith:
Typically, I recommend trying conventional treatments for at least 3 to 6 months before considering use of SCS. However, in special cases, such as patients with CRPS, SCS should be used sooner because the success rates plummet if pain persists for more than a year. This is because the pain pathways become rewired in people with have CRPS for more than one or two years, making it harder to reverse the condition.

Q: What types of physicians use SCS in the treatment of chronic back and neck pain?
Dr. Highsmith:
Typically, SCS is used by pain management physicians such as anesthesiologists, physiatrists, orthopedic spine surgeons, and neurosurgeons. Also, SCS is increasingly being used by neurologists for other conditions such as occipital neuralgia (a form of severe headache), general surgeons to treat nerve pain from hernias, and cardiovascular surgeons for intercostal neuralgia (rib pain following surgery).

Q: What advice do you give patients about selecting a physician who is knowledgeable about SCS?
Dr. Highsmith:
First of all, choose a physician who is experienced with SCS. Typically, physicians who have treated 20 to 30 patients with SCS are considered experienced.

Also, appropriate patient selection and expectations are equally important. Each patient should undergo a SCS trial before the device is implanted to make sure that the pain is relieved by this treatment. Unfortunately, patients may be desperate for relief and request SCS implantation, even if they do not have a good response to the SCS trial. If the SCS trial is not positive, the SCS should not be implanted, and other treatments should be offered.

Q: What questions should patients ask their physicians when considering treatment with SCS?
Dr. Highsmith:
Patients should ask their physicians, “Is there any structural problem with my spine that should be addressed first?” Pain doctors may refer people for SCS when they actually have a true mechanical problem that could be corrected with an operation.

Q: What is your clinical experience with spinal cord stimulation?
Dr. Highsmith:
Spinal cord stimulation is a major part of my practice. I implant approximately 100 spinal cord stimulators each year. Initially, I started using SCS as a last resort tool for people with chronic back pain after surgery. Now, I also use SCS for treating pain that does not respond to less invasive options. I am currently involved in the research and development of spinal cord stimulation devices.

See our other articles about SCS:

Updated on: 09/12/17
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