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NOLAN TZOU, M.D.

Diplomate American Board of Anesthesiology
and Pain Management

Spinal Cord Stimulation Treatment

What is Spinal Cord Stimulation (SCS)?

Spinal cord stimulation (SCS) is a medical therapy for people who suffer from certain types of chronic pain. SCS involves the use of an implanted device—a spinal cord stimulator (sometimes called a generator or pacemaker for pain)—to deliver mild electrical pulses directly to nerve fibers. This direct approach to treating pain at its source can be very effective.

Spinal cord stimulation has three significant advantages:

  • SCS can be very effective in reducing chronic pain from certain conditions
  • You can have an SCS trial before you have a permanent system implanted, which allows you to see if the therapy works for you
  • The implanted device can be turned off permanently or removed if you do not achieve the desired level of relief
  • Each type of SCS system has advantages and disadvantages. Should you consider getting a spinal cord stimulator, you and your physician will decide which system is best for your situation. This decision will be based on factors such as your pain pattern, your lifestyle, and how much electrical energy is required to provide adequate pain relief.

SCS Trial Information (What to Expect Before)

If you are a candidate for spinal cord stimulation (SCS), you will probably have a stimulation trial first, to find out how well you respond to SCS, before you commit to a full system implantation. During the SCS trial, a lead or leads are implanted temporarily and are connected to a trial spinal cord stimulator. Then, the trial stimulator is programmed with one or more stimulation programs that are customized to cover your areas of pain.

The SCS trial allows you to:

  • Decide if spinal cord stimulation therapy is effective for the type, location, and severity of your chronic pain.
  • Evaluate the effectiveness of different stimulation settings and programs.
  • Help decide which system (conventional implantable pulse generator, rechargeable implantable pulse generator, or radiofrequency) will provide the greatest possible level of relief, both immediately and over time, if your pain gets worse or spreads.

If spinal cord stimulation does provide sufficient pain relief, a second procedure will be scheduled to implant additional components, after you and your physician select your permanent system.

If spinal cord stimulation does not work for you, the trial system is removed and you can explore other options.

Before the procedure, your ANS representative will explain what will happen during the procedure and answer any questions. Next you will be taken to a surgery suite and placed on your stomach on the procedure table. The nurse will make you as comfortable as possible and monitor your heart rate. The anesthesiologist may give you medication to help you relax. This medication may make you feel drowsy too.

What to Expect During the Trial Procedure

During the procedure, the physician will place one or more leads in the area along the spinal cord. The leads are typically inserted using a small needle. The exact placement depends upon the location of your pain.

Once the leads are placed, your participation begins. You will be woken up and your leads will be tested to be sure they are in the right place to treat your pain. You will be asked questions such as, "Do you feel a tingling sensation: Where do you feel the tingling? Does the tingling cover your pain?" By answering these questions, you will help make sure the leads are positioned well.

Finally, a dressing will be applied to cover the area where the leads exit your back. Then you will be taken to a recovery room.

What to Expect During the Permanent Procedure

Before the procedure starts, you will be lightly sedated. Your trial leads (if present) will be removed. If percutaneous (under the skin) leads are used, a local anesthetic will be administered while the leads are placed, then you'll be put under general anesthesia while the rest of the system is implanted. If surgical leads are used, you'll likely be under general anesthesia the entire time.

Once the leads and generator are in place, connected and working, your surgeon will apply sutures and dressings, and you'll be slowly withdrawn from anesthesia.

What to Expect After the Trial Procedure

Once you are settled in the recovery room, your SJM representative will most likely visit with you. Under the supervision of a physician or nurse, your representative will show you how to use the stimulator to change programs (if you are given more than one program) and how to adjust the strength of the stimulation so you can experiment with what makes you comfortable.

Before you leave the hospital or surgery center, you will learn to care for the area around the leads. You will be instructed to keep the area dry. This means you can only take sponge baths during the trial period. You will also be told what activities to avoid, such as extreme lifting and bending. However, you may be encouraged to try light activities, such as walking, so you can see if SCS therapy relieves your pain enough to allow you to do more of the things you want to do.

When you get home, you will be able to test how well the stimulation helps control your pain throughout the day and during different activities. You will jot notes in your trial diary to track which programs you use and how the stimulation covers your pain. Several days of more after surgery, you will either return to your physician's office for a follow-up visit, or a member of the physician's staff will call you to see how you are doing. At the end of the trial period, you and your physician will decide if you should have a permanent system and, if so, which type of system is appropriate.

What to Expect After the Permanent Procedure

After the procedure, you'll rest quietly until the physician taking care of you decides you're awake and well enough to leave. Keep in mind that, while most patients are sent home the same day, your physician may decide you require a longer hospital stay.

Before you are released from the hospital or day surgery unit, you will learn how to care for your incisions and will be told what activities you should do or avoid. You may get several programs to try for a week or so, after which any needed adjustments will be made on a return visit to your physician's office. You'll learn how to adjust the level of stimulation to manage your pain as it changes throughout the day. Any questions you may have about living with your SCS system will be answered, and you'll receive a video and a detailed user's guide with phone numbers to call for more information.

In general, you should avoid getting your incisions or sutures wet. This means you will have to take sponge baths until your physician says you can bathe or shower again. You should also keep your incision site clean by changing your dressing and applying ointments as directed by your physician. If you notice drainage, pus, redness, or swelling in the incision area, if you have fever or chills, or if you feel excessive pain, call your physician immediately. These symptoms could signify an infection.

The weeks following your implantation surgery can be an exciting time as you become familiar with your spinal cord stimulator, begin to take control over chronic pain, and gradually begin to do more of the things that you want to do. Most patients find that living with a spinal cord stimulator requires no extra time or effort in their life, which can be an important first step toward a healthier, more active, and more fulfilling lifestyle.