Spinal Cord Stimulation for Chronic Pain

Spinal cord stimulation (SCS) is a procedure that uses an electrical current to treat Reference chronic pain Opens New Window. A small pulse generator, implanted in the back, sends electrical pulses to the spinal cord. These pulses interfere with the nerve impulses that make you feel pain.

Implanting the stimulator is typically done using a Reference local anesthetic Opens New Window and a Reference sedative Opens New Window. Your doctor usually will first insert a trial stimulator through the skin (percutaneously) to give the treatment a trial run. (A percutaneous stimulator tends to move from its original location, so it is considered temporary.) If the trial is successful, your doctor can implant a more permanent stimulator. The stimulator itself is implanted under the skin of the belly (abdomen), and the small coated wires (leads) are inserted under the skin to the point where they are inserted into the spinal canal. This placement in the abdomen is a more stable, effective location.

After this outpatient procedure is complete, you and your doctor determine the best pulse strength. You are then told how to use the stimulator at home. A typical schedule for spinal cord stimulation is to use it for 1 or 2 hours, 3 or 4 times a day.

When in use, the spinal cord stimulator creates a tingling feeling, rather than the pain you have felt in the past.

You will have a small incision that you should keep clean and dry until it heals.

This treatment may be done for people with severe, chronic pain who have:

• Reference Failed back surgery syndrome Opens New Window.
• Severe nerve-related pain or numbness.
• Chronic pain syndromes, such as Reference complex regional pain syndrome Opens New Window.

Spinal cord stimulation is typically considered investigational for various other conditions, including Reference multiple sclerosis Opens New Window, paraplegia, and intractable Reference angina Opens New Window.

There isn't a lot of evidence to show how well spinal cord stimulation works. It seems to help certain types of chronic pain, such as failed back surgery syndrome and complex regional pain syndrome.^{Reference 1} Spinal cord stimulation may also help chronic low back pain.^{Reference 2}

Some researchers have reported that more than half of people receiving spinal cord stimulation for chronic low back and leg pain, ischemic leg pain (for example, from Reference peripheral arterial disease Opens New Window), or complex regional pain syndrome have pain reduction or relief.^{Reference 3}

Initial pain relief is often followed by a gradual decline in effectiveness, apparently caused by the body's increasing tolerance to the treatment.

Possible risks related to spinal cord stimulation include:

• Scar tissue (fibrosis) developing around the electrode.
• Pain gradually moving beyond the reach of the nerve stimulator.
• Breakage of an electrode or hardware failure.
• Infection.
• Leakage of spinal fluid.
• Headache.
• Bladder problems.
• Getting used to the stimulation, making it less effective.

People with an implanted stimulator can't have Reference magnetic resonance imaging (MRI) Opens New Window tests.

There is still not strong proof that spinal cord stimulation works. Better research is needed. Treatment success varies widely and is influenced by the cause of pain.

Spinal cord stimulation may be recommended for some people who have certain types of chronic pain.

Most spinal cord stimulator batteries must be replaced every 2 to 5 years.

Complete the special treatment information form (PDF) (What is a Reference PDF Opens New Window document?) to help you understand this treatment.

Citations

1. Mailis-Gagnon A, et al. (2004). Spinal cord stimulation for chronic pain. Cochrane Database of Systematic Reviews (3).

2. Taylor RS, et al. (2005). Spinal cord stimulation for chronic back and leg pain and failed back surgery syndrome: A systematic review and analysis of prognostic factors. Spine, 30(1): 152–160.

3. Cameron T (2004). Safety and efficacy of spinal cord stimulation for the treatment of chronic pain: A 20-year literature review. Journal of Neurosurgery, 100(3, Suppl Spine): 254–267.

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