Conditions Treated

The most common condition treated by spinal cord stimulation is back pain, especially back pain that remains or worsens after back surgery.

Other chronic pain conditions that a spinal cord stimulator treats include the following:

• Angina (heart pain)
• Spinal cord injuries
• Complex regional pain syndrome
• Nerve pain (e.g., diabetic neuropathy or severe neuropathic pain related to cancer treatments, like radiation or chemotherapy)
• Post amputation pain
• Abdominal pain
• Pain in the internal organs (visceral pain)
• Inflammation of the membrane that covers the brain and spinal cord (arachnoiditis)

Benefits

There are many spinal cord stimulation benefits for those with unresponsive chronic pain.

To start, the device and corresponding effects are adjustable. Pain levels vary among people, and spinal cord stimulators can respond. You have control of the frequency and intensity of the stimulation. Pain control is completely adjustable as needed.

Spinal cord stimulation is also minimally invasive. The procedure is a surgical one, but only one small incision is needed to place the spinal cord stimulator generator. The leads are placed with a hollow needle.

Finally, this approach can reduce opioid use among those with severe chronic pain. A 2018 study found that 71% of people with a spinal cord stimulator were able to significantly reduce or eliminate their use of opioids.

In addition, spinal cord stimulation has few side effects, is a cost-effective treatment option, and is very low maintenance. Ongoing studies continue to prove the effectiveness of spinal cord stimulation for a variety of chronic pain conditions. Talk to your doctor to see if this treatment is right for you!

Procedure

The spinal cord stimulation procedure occurs in two phases: a trial and a permanent implant.

Phase 1: The trial

A trial period is important in the spinal cord stimulation procedure. This helps to see if the treatment is effective for you before your doctor implants a more permanent device.

Your doctor will offer light sedation and apply a numbing solution to the area where the leads are to be placed. The leads are guided into the epidural space. Your doctor may use X-ray guidance (fluoroscopy) to ensure proper placement.

Once the leads are inserted in the approximate location, your doctor will ask you to assess the pain relief. You may feel a mild buzzing sensation, or you may feel no pain. Once the location is verified, the trial surgery is complete.

You’ll wear the generator discreetly outside of your body during the trial, which lasts about two weeks (sometimes less).

Phase 2: Permanent implant

If your trial is successful, a permanent placement will occur. The name of this phase is misleading, though, as the spinal cord stimulation procedure is totally reversible.

The leads and generator can be removed any time you wish to stop treatment. The main difference is that the generator will also be surgically implanted at this time. You may have new leads implanted in the epidural space, but this may not be necessary.

As with the trial spinal cord stimulator, this outpatient procedure is performed under sedation. Once the leads are in place, your doctor will wake you up to make sure they are still providing relief before continuing the procedure.

For the generator, you and your doctor will discuss in advance where you would prefer it to be placed. A small flap of skin is opened to place the generator. Generally, the generator is located discreetly under the skin in the buttocks, abdomen, or chest. Finally, your doctor will close the surgical site and you will be wheeled into a recovery area to rest briefly.

Recovery

Spinal cord stimulation recovery is generally easy and relatively comfortable. Each spinal cord stimulation procedure (both the trial and permanent implantation) are performed as outpatient surgeries. You will relax in recovery until your anesthesia wears off. You’ll need a friend or family member to drive you home. Plan to rest and take it easy for the remainder of the day.

You may feel a bit sore at the surgical site. This is normal. Take care to not twist or stretch in a way that might place strain on the site. Avoid vigorous workouts or heavy physical activities until your doctor clears you.

Keep the dressings on your incision site clean and dry. They can be removed after three days (or as directed by your doctor). Your incisions should heal completely two to four weeks after surgery. This is a good time to return to previous levels of activity, including work, exercise, and driving, once okayed by your doctor.

If you are prescribed any medications, take them only as directed.

Risks

Although generally recognized as safe, all medical procedures come with risks and the possibility of side effects. Spinal cord stimulation risks include:

• Bleeding
• Infection
• Movement of the generator or leads
• Damage to the generator (in a fall or other accident)

Serious but rare side effects include spinal cord trauma or damage and dural puncture. A dural puncture can cause severe headaches.

When it comes to living with spinal cord stimulation, side effects are often rare, mild, and well-tolerated. Some people do not like the buzzing sensation produced by the electrical current. Others report discomfort sleeping due to generator placement. The best way to avoid these side effects and risks is to talk to your doctor before your procedure.