Dr. Eric DePopas, MD
PainTheory Chief Medical Officer
Vascular & Interventional Radiologist
One of the most promising procedures for chronic pain is spinal cord stimulation. Spinal Cord Stimulation is a minimally-invasive, highly-effective treatment for chronic back and leg pain. Here’s all you need to know about spinal cord stimulation.
DID YOU KNOW?
Spinal cord stimulation has been found to promote meaningful pain relief in 50-70% of chronic pain patients who failed to respond to other treatments. Source
Table of Contents
What is a spinal cord stimulator?
A spinal cord stimulator is a small medical device—similar to a pacemaker—that uses electrical impulses to interrupt pain signals before reaching the brain.
A spinal cord stimulator consists of two components:
Pulse Generator:
A small battery pack with a computer chip that sits just beneath the skin and produces electrical impulses.
Electrodes:
Electrodes—also called “leads”—are thin, flexible wires that carry electrical impulses from the pulse generator to the nerves entering the spinal cord.
Who is a candidate for spinal cord stimulation?
Spinal cord stimulation works best for patients with:
Chronic pain after back surgery (Failed Back Surgery Syndrome).
Chronic back pain that has not resolved with treatments like physical therapy, medications, and injections.
Chronic pain that radiates down the leg(s).
Chronic pain related to diabetic neuropathy.
Pain related to Chronic Regional Pain Syndrome (CRPS).
What makes spinal cord stimulation unique from other treatments?
The two factor that make spinal cord stimulation different than other treatments are:
1
Effective when other treatments fail
Spinal cord stimulation (SCS) works when all other forms of therapy have failed. People who have tried everything and are at their wits’ end now have an option. Research shows that SCS results in meaningful pain relief in 50-70% of well-selected chronic pain patients that have failed to respond to other treatments. Source
2
Trial before committing
One of the most unique aspects of spinal cord stimulation is that patients can try the device for up to 7 days before committing to a long-term implant. The trial period ensures patients get adequate pain relief prior to implantation.
The trial procedure:
Takes place in the outpatient setting.
Only requires local or twilight anesthesia.
Requires no hospital stay.
Recovery from a stimulator trial is comparable to that of a routine epidural steroid injection. Once the trial device is inserted, you then go about your routine activities for up to 7 days. If patients aren’t comfortable with the device or if the device does not provide adequate relief, the trial device is removed.
Summary of current spinal cord stimulation research
Here are findings from 3 major meta-analyses on spinal cord stimulation:
PHYSICIAN INSIGHT
A “meta-analysis” is a study where researchers aggregate findings from all previous relevant studies to formulate stronger conclusions.
Finding 1
Increased odds of reducing pain by 50%
In patients with intractable spine/limb pain, spinal stimulation was associated with better pain reduction than medical therapy. New stimulation technology was likely associated with better pain reduction than conventional stimulation. Source
Finding 2
Higher prevalence of patients returning to work
Chronic pain has a substantial negative impact on work‐related outcomes, which underscores the importance of interventions to reduce the burden. The below meta-analysis concluded that SCS intervention resulted in a higher prevalence of patients returning to work. Source
Finding 3
Reduced pain medication consumption
In patients with intractable spine/limb pain, SCS was associated with increased odds of reducing pain medication consumption. Source
What is the process of getting a spinal cord stimulator?
The 4 steps required to receive a spinal cord stimulator are:
1
Evaluation by a medical doctor
If you think you’re a candidate, discuss spinal cord stimulation with your interventional pain doctor. An interventional pain doctor specializes in using non-surgical, minimally invasive procedures to reduce pain.
2
Psychological evaluation
To ensure the best outcome possible, patients must undergo a psychological evaluation prior to beginning a spinal cord stimulator trial. The intent is to address any underlying issues related to anxiety or depression.
3
Spinal cord stimulator trial
Before a permanent spinal cord stimulator is inserted, a trial is performed to ensure adequate pain relief.
A spinal cord stimulator trial is considered successful if:
Your pain is reduced by at least 50%.
You’re able to return to activities that matter to you.
Your need for pain medication is reduced.
You’re able to relax and sleep better.
4
Implantation
If the trial run is successful, a minimally invasive procedure is performed to place a permanent stimulator. Most patients leave the day-of their procedure.
Recovery
The spinal cord stimulator is programmed before leaving the surgery center. Approximately 10 days after the procedure, the incision is checked to ensure adequate wound healing and the device is fine-tuned.
What are the risks associated with the procedure?
Complications are rare but include:
Bleeding at the site of implantation.
Infection requiring device removal. Infection rates can be as low as 1%, but may rise to 4% in some centers.
Displaced leads or fractured electrodes requiring repositioning.
Does insurance cover spinal cord stimulation?
Spinal cord stimulation is covered by most major insurers including:
Medicare.
Medicaid (varies based on the state).
Nearly all commercial payers.
Most workers’ compensation programs.
DID YOU KNOW?
Many physicians offer out-of-pocket discounts for patients who do not have insurance but would still like to pursue treatment. Generally, the out-of-pocket cost is significantly lower for patients who do not have insurance.
What’s it like living with a spinal cord stimulator?
Living with a spinal cord stimulator is easy for most. You'll have:
Remote control
Allowing easy programming of the stimulator based on your individual needs. Factors such as stimulation strength, duration, and body coverage can be changed.
Stimulator settings
Back pain often changes based on the activity (sitting versus standing), and the spinal cord stimulator can be programmed to deliver maximum relief based on the activity you are performing.
Here are additional key points about living with a stimulator:
Microwaves, cell phones, pagers, and anti-theft sensors cannot damage your spinal cord stimulator.
Your doctor will let you know if your type of stimulator is MRI compatible.
Remember to carry your implanted medical device card at airports as the stimulator can be detected at airport security gates.
How do I pick a good doctor for spinal cord stimulation?
Here are the keys to picking a good doctor:
First
Pick a doctor who performs SCS regularly
You want someone that has significant procedural skill and judgement. When you call the clinic, don’t hesitate to ask the front desk personnel how frequently the doctor performs spinal cord stimulation.
Second
Look for a doctor who is fellowship-trained
Look for doctors who are fellowship-trained in pain management and minimally invasive procedures. These doctors are usually highly skilled in the diagnosis and treatment of pain because they have training exclusively within the field of pain management.
