Overview
Spinal cord stimulation (SCS) employs the use of electrical impulses to relieve pain emanating from different parts of the body. The concept behind pain relief imparted by SCS is known as the “Gate Control Theory of Pain”. It is the theory that the electrical impulses disrupt the pain signals from reaching the brain and registering as pain.
Candidates
Traditionally SCS therapy has been reserved for conditions such as chronic neuropathic pain (radiculopathy), chronic regional pain syndrome (CRPS), peripheral neuropathy and phantom limb pain. Over the last few years, the therapy has been extended to help those individuals with axial pain (neck/back pain).
Trial Period
One of the advantages of SCS therapy is that the patient is allowed a “trial” period which may last anywhere between 3 and 10 days. The leads are placed with the use of needles which may take place in office or outpatient surgery center. Typical procedure lengths are anywhere between 30 and 90 minutes. During the procedure, the patient is lightly sedated, but they are able to confirm the correct placement of the leads as the device is turned on intraoperatively to ensure the stimulation is felt in the patient’s typical pain areas.
Following the procedure, the external battery is taped down to the patient’s skin and the device is worn externally for the length of the patient’s trial. During the trial period, the patient has access to a remote control which imparts several programs and settings which the patient may change to obtain maximum benefit.
Permanent Implantation
At the conclusion of the trial period, the patient returns to have the leads removed in office. If the patient reports acceptable benefit, then the decision is made to proceed to permanent implantation of the device. For the permanent implant, the leads and Implantable Pulse Generator (IPG) are surgically placed underneath the skin under general anesthesia.
Post Implant
The post procedure period allows three months of limited activity to allow the leads to scar down into a fixed position. Thereafter, restrictions are lifted, and the patient is able to control the device from a wireless control with multiple programs and settings to achieve maximum benefit.