David S. Klein, M.D.

Spinal Cord Stimulation

There have been many improvements in the treatment of chronic pain. Many patients benefit from a variety of treatment approaches, but there are those patients for whom relief is not so easily achievable. Better understanding of the chemical and physical mechanisms of pain has led to newer, very sophisticated approaches to the relief of pain.

One new therapy that offers potential for relief of intractable pain is SPINAL CORD STIMULATION. Spinal cord stimulation, or SCS, is the technique of electrical stimulation of a precise portion of the spinal cord, with very low energy current, which essentially shuts down the input of pain fibers from a desired portion of the body. The technique provides pain relief, but does not interfere with normal sensation, normal muscular ability, or any other bodily function.

SCS is accomplished using a small wire electrode, or lead, which is passed through the skin, and comes to rest close to the spinal cord, along the segment of the cord that is involved with a patient's pain. One end of the lead rests in what is called the "epidural space," and, the other end is attached to a battery operated signal generator, about the size of an oatmeal cookie. After the SCS lead is placed properly, the signal generator is adjusted to provide a "pattern" of stimulation that provides maximal pain relief for the patient.

Not all patients are candidates for this therapeutic approach, but for those who are, relief can be expected in patients between 70% and 80% of the time.

INDICATIONS FOR SCS TREATMENT

1. Failed Back Surgery Syndrome
2. Adhesive Arachnoiditis
3. Phantom Limb or Stump Pain
4. Peripheral Neuropathy
5. Reflex Sympathetic Dystrophy (RSD), Causalgia, and Complex Regional Pain Syndrome (CRPS)
6. Ischemic Pain

PATIENT SELECTION

Generally, successful outcome is most likely if thoughtful patient selection is carefully observed. Patients do best if most of the pain is experienced in the limbs, if the patient demonstrates minimal psychological difficulty, and if there is no substance abuse.

SCS TECHNIQUE

The SCS procedure is essentially a two-step modality. The first step involves the use of a temporary lead, which is placed through the skin to the targeted level of the spinal cord. The temporary lead exits the skin and is attached to a battery-signal generator which is worn on the belt. The temporary, or trial lead, is used for 3-5 days.

If satisfactory pain relief is obtained, the temporary lead is removed, and a permanent lead is placed at the same location, but the remainder of the lead, and signal generator are implanted under the skin. The signal generator is about the size of a pacemaker battery, which is quite small.

After placement under the skin, and after the bandage is removed, normal activities are possible. Little special care is required for the system, although periodic medical evaluation is a good idea. There are very few special considerations, and many patients return to a more normal, satisfying life.

PLEASE NOTE:

There are remarkably few circumstances where relief of pain is unachievable. The diagnostic skill of the physician is the most important determinant of successful treatment of pain. Judgement, which is the ability to properly decide which of many therapeutic paths to choose, is also important. Without  technical skill, or the physical ability to perform a medical procedure, the ability to treat a complicated patient fails.

Before considering any intervention, it is extremely important that the patient makes certain that the physician is properly informed, properly trained, and uses the highest quality equipment.

David S. Klein, MD, FACA, FACPM, FACMIMS
Director, Pain Center of Orlando
www.suffernomore.com