Spinal Stimulation and Chronic Back Pain

Spinal stimulation is a treatment option that could help bring relief from pain and improve the quality of life for individuals dealing with chronic low back, and leg pain. Spinal stimulation can help reduce and manage chronic pain that does not alleviate or reduced with physical therapy, pain medications, injections, and other non-surgical treatments/therapies.

It is a form of neuromodulation that works by blocking pain signals that the nerves send out from reaching the brain. A spinal stimulator is a tiny device that is implanted underneath the skin. The device delivers a very low electrical impulse that masks/changes pain signals before they reach the brain.

A Spinal Stimulation System

Neurostimulator:

This is the entire device that is implanted and sends out electrical impulses through a lead wire to the nerves in the spine.

Lead:

The thin wire delivers the electrical impulses from the neurostimulator.

Remote control:

This turns on/off the stimulator and increases or decreases the amount of stimulation.

Charger:

Stimulators are rechargeable and normally require recharging for about one hour every two weeks.

Spinal Stimulator Types:

Traditional stimulators

These produce a gentle ringing/tingling sensation that masks the pain.

Burst stimulators

These send out random interval bursts of electrical impulses designed to copy the way the body sends out nerve impulses.

High-frequency stimulators

These reduce pain without generating tingling sensations.

Types of Pain Spinal Stimulation Treats

Spinal stimulation is approved by the U.S. FDA to treat chronic back and leg pain, including pain that doesn’t go away after back surgery known as failed back surgery syndrome. Chronic neuropathic back and leg pain are the most common types that stimulation treats. This means back or leg pain caused by nerve damage from:

• Auto accident
• Injury – personal, sports, work
• Disease

Acute pain is like stepping on a sharp piece of glass, where the pain serves as protection letting you know something is wrong and not to continue. Whereas chronic neuropathic pain lasts for 3 months or more and does not help protect the body.

Spinal stimulation is also used to treat complex regional pain syndrome or CRPS. This is a rare condition that affects the arms/hands or legs/feet and is believed to be caused by damage or malfunction of the nervous system. It is also used in treating peripheral neuropathic pain. This is damage to the nerves outside of the spinal cord often in the hands/feet that is caused by an:

• Infection
• Trauma
• Surgery
• Diabetes
• Other unknown causes

Appropriate Treatment

Spinal cord stimulation should not be used in patients that are pregnant, unable to operate the stimulation system, went through a failed trial of spinal stimulation, and are at risk for surgical complications. The decision to use spinal stimulation is based on an individual’s needs and risks. Talk to a doctor, spine specialist, or chiropractor to see if spinal stimulation could be an option.

Benefits and Risks

The effects of stimulation are different for everyone. Therefore, it is important to understand that spinal stimulation can help reduce pain, but not completely eliminate it.

The Benefits of Spinal Cord Stimulation

In addition to reducing pain, other benefits of spinal stimulation include:

• Better sleep
• Improved body function
• Increased activity
• Improved mobility
• Reduced opioid medication/s use
• Less need for other types of pain meds
• Reduced dependence on braces/bracing

Risks

During the implantation, there is a risk for:

• Bleeding
• Infection
• Pain at the site of incision
• Nerve damage
• Rarely paralysis

For some individuals, scar tissue can build up over the electrode, which can block the stimulator’s electrical impulse. The lead wire could move or shift out of position. This could lead to impulses being sent to the wrong location. The device itself could shift under the skin causing pain and making it hard to re-charge or communicate with the remote.

There is a risk that the lead wire could detach or break off causing a malfunction and requiring a replacement. Also, individuals could respond well to the stimulation at first, but later on, they develop a tolerance, and so the therapy no longer has the same impact and the pain could get worse because the nerves stop responding.

Take Precautions

Discuss with a doctor, spine specialist, or chiropractor what you can and can’t do after the stimulator is implanted and activated. Here are a few precautions:

• Do not drive or operate heavy equipment when the stimulator is active.
• Stimulation systems could set off metal detectors, which could require manual screening.

MRIs, electrocautery, diathermy, defibrillators, and cardiac pacemakers could have a negative interaction with certain types of stimulators. This could result in injury or damage to the spinal stimulator. Talk to your doctor to determine if a spinal stimulator is a treatment option that will work for you.

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