Spinal Cord Stimulation (SCS)

What is chronic pain? Chronic pain is defined as persistent pain that has not gone away or recurs frequently even after six months have passed. (1) While the pain may not be constant, it affects the daily life of many patients with chronic pain.

 

How common is chronic pain? One in three Americans suffer from chronic pain; (2) more than 100 million people are partially or totally disabled by pain (3) and 40 percent of Americans experience daily pain.(4) It is the number-one cause of adult disability in the United States.3 The annual national economic cost of chronic pain in the United States is an estimated $560 to $635 billion.(5)

How does chronic pain affect lives? Constant chronic pain can impact an individual’s personal life, career, family and friends. It can interfere with every aspect of a person’s life: relationships, self-esteem and emotional well-being.

 

What causes chronic pain? Chronic pain has many different causes. Sometimes normal aging may affect bones and joints in ways that cause chronic pain. Other common causes are nerve damage and injuries that fail to heal properly. In many cases, however, the source of chronic pain can be so complex, it is difficult to diagnose.

 

What are the choices for patients who suffer from chronic pain? Conservative treatment options include over-the-counter medications like ibuprofen and physical therapy. More powerful drugs such as opioids can also be prescribed, but they can carry the twin dangers of addiction and a diminished ability to function. Invasive surgeries like spinal operations are another choice, but the recovery time is often lengthy. Spinal Cord Stimulation (SCS) is another proven, non-addictive option that delivers mild electrical signals to the spinal cord to mask pain signals. It is a reversible therapy that has helped thousands of people find relief from chronic pain.

 

What is Spinal Cord Stimulation (SCS)? SCS may offer hope for many of the estimated 100 million people who suffer from chronic pain. SCS works by using mild electrical impulses to the spinal cord, masking the pain message traveling to the brain. Depending on the type of stimulation therapy used, the painful sensation may be replaced with a soothing, tingling sensation or no sensation at all.

 

SCS may be prescribed for chronic intractable pain of the trunk and/or limbs, including unilateral or bilateral pain associated with failed back surgery syndrome or intractable low back pain and leg pain. Many people with failed back surgeries have had success with SCS. It is most commonly used to treat low back and lower extremity pain.

 

What are the steps of an SCS procedure?

Trialing

One of the advantages of SCS therapy is that the patient gets to test drive an external version of the device to see if SCS is effective for their pain.

 

At the beginning of the trial period, the physician places insulated leads with a simple procedure similar to an epidural injection. The leads are connected to an external trial stimulator that is tucked inside an external belt. The patient also gets a wireless remote control so they can increase or decrease the electrical impulses to manage their pain. The external version is typically worn anywhere from a few days to one week. This trial period gives the patient the opportunity to decide if SCS manages their pain.

 

Permanent Implantation

 

After the trial device, the patient and physician decide whether or not SCS is a therapy option that best suits their needs. If they decide to go forward, then the patient will undergo another procedure during which the physician implants leads and a stimulator called an Implantable Pulse Generator (IPG). In some cases, a physician may recommend a surgical lead, also known as a paddle lead. In this case, the paddle lead is placed at the target site during the surgical procedure. Patients may remain awake during this procedure, under local anesthesia and light sedation. In other cases, general anesthesia may be administered.

(1) Dubois, M., Gallagher, R., & Lippe, P. (2009). PAIN MEDICINE POSITION PAPER. Pain Medicine, 10(6), 972-1000. doi: 10.1111/j.1526-4637.2009.00696.x.

(2) American Chronic Pain Association. (2018). Partners for Understanding Pain: Healthcare Professionals September 2018 [Ebook]. Retrieved from https://www.theacpa.org/wp-content/uploads/2018/07/Tool-Kit-2018.pdf.

(3) AAPM Facts and Figures on Pain. (2018). Retrieved from http://www.painmed.org/patientcenter/facts_on_pain.aspx.

(4) Johannes, C., Le, T., Zhou, X., Johnston, J., & Dworkin, R. (2010). The Prevalence of Chronic Pain in United States Adults: Results of an Internet-Based Survey. The Journal Of Pain, 11(11), 1230-1239. doi: 10.1016/j.jpain.2010.07.002. https://www.jpain.org/article/S1526-5900(10)00601-2/fulltext.

(5) Institute of Medicine. Relieving pain in America: a blueprint for transforming prevention, care, education and research. Washington, DC: National Academies Press, 2011.

Advanced Pain Management

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