7901 SW 34th Ave

Amarillo, TX 79121

Victor M. Taylor, MD, DABA

Board Certfied Pain Management

Ph: 806-352-7431

Fax: 806-352-2374

Physical Rehabilitation in Chronic Pain | Opioids and Chronic Pain | Approach to Treatment

Spinal Cord Stimulation

 

What it is used to treat?

 

Spinal cord stimulation is used to treat intractable or unremitting pain in the extremities such as the arms or legs that is due to neuropathy, radiculopathy or nerve damage.  Spinal cord stimulation is used in patients who have undergone other types of treatment including epidural steroids, surgery, lysis of adhesions and have not gotten adequate relief from their pain.

 

Spinal cord stimulation is also used in patients who have phantom limb pain, complex regional pain syndrome, and peripheral neuropathy including diabetic peripheral neuropathy.

 

Studies if shown spinal cord stimulation can also be used for patients with severe peripheral vascular disease.

 

What the goal/purpose?

 

The goal of spinal cord stimulation is to block the pain signals from making their way from the spinal cord level to the brain.  The purpose of spinal cord stimulation in chronic pain is merely to control the pain and allow for better function in a more enjoyable life for the patient.

 

In other parts of the world spinal cord stimulation can be used as a treatment for an underlying disorder such as peripheral vascular disease.

 

What should I do to get ready for the procedure?

 

Stop taking any medication that thins the blood at least 5 days prior to the procedure. These medicines include Aspirin, and most over the counter pain medicines except Tylenol.   Read the list of medications that must be stopped that was given to you at your office visit.  Make sure it is ok with your prescribing doctor before you stop prescription blood thinners used for treatment of heart disease, peripheral vascular disease, irregular heartbeat or history of stroke.  It is your responsibility to clear this with your doctor.

 

Continue to take your other medications.  Do not stop blood pressure or diabetes medicines.

 

Do not eat or drink anything on the morning of your procedure.  You may eat and drink afterward.

 

The week that the procedure is scheduled, you will be required to have preadmit lab work performed at the hospital, where you are having the procedure done. This lab work helps us to assure that you do not have a current infection or thinner than normal blood, both of which would make proceeding with the procedure potentially dangerous.

 

How is it done?

 

Spinal cord stimulation is a three-phase procedure.  The initial phase consist of evaluation and testing to ascertain whether or not a person is a good candidate for spinal cord stimulator.  In addition to the normal history and physical exam performed by your doctor, diagnostic imaging including CT scans or MRI of the appropriate areas will be necessary.  Psychological testing is mandated under the guidelines for implantation of spinal cord stimulators.  The psychological test may include a simple test taken in our office or may include evaluation by a licensed psychologist or psychiatrist.

 

The second phase of spinal cord stimulation consist of a trial period.   In the trial 1 or 2 soft stimulator leads are placed into the epidural space under fluoroscopic guidance.  The trial is performed in the operating room for sterility, but is not a surgery.  The trial is done through an epidural needle in the same way and epidural for a woman in labor is done.

 

Once the trial leads are in place, they are simply bandaged in position.  The patient goes home for several days and basically gets to “test drive” the device and make sure it works for them.  After the trial period is over, the patient returns to the hospital or office in the leads are removed.

 

The third phase is reserved for patients getting worthwhile relief during the trial period. These patients will be referred to a neurosurgeon for permanent stimulator placement.

 

What is injected/placed?

 

Skin anesthesia is performed with lidocaine, a common local anesthetic.  Some sterile preservative-free normal saline is injected while entering the epidural space.  Occasionally radiocontrast is used.  The leads are then placed.

 

Will it hurt?

 

Most people tolerate these procedures very well.  Typically the spinal cord stimulator trial is no more uncomfortable than an epidural injection. There is some discomfort associated with numbing the skin and there may be pressure during the injection.  Some patients require some sedation for the procedure, and others do not. The vast majority of patients tell us ‘that wasn’t so bad” or “I can’t believe I was worried about that;” however some people do find it painful and may require sedation. As with all her procedures sedation is available.

 

Important Warning!

 

With the spinal cord stimulator there is a lot going on.  The company that provides the devices to the hospital and doctors also provides technical representatives to help patients learn to use the device.  If there is any confusion do not hesitate to call the company representatives for help.  They are there to help you with technical use of the device.

 

It is very important during the trial period to actually try the device out.  During the initial day of the trial take your activity slowly.  Keep a diary of how you’re doing with the device.  In days 2 and beyond you can be more aggressive with twisting and turning and doing more aggressive work once you have made a decision whether or not you like the device.  Too much twisting or activity can lead to movement of the device and loss of the ability of the lead to cover your pain.

 

What is the chance of success?

 

Approximately 80 % of our patients get significant relief have or enough relief with the trial that they go on to permanent placement of the device.  Of the patients who undergo permanent placement, roughly half think the device almost miraculous and are seldom seen in our office afterwards.  Of the other 50%, the majority are pleased with the results of the device, but still have some pain issues and may still require medication and even occasional injections.  A few patients will not have good long-term success with the implant.

 

What can I do to maximize my chance of success?

 

In the initial months after the devices placed, it may need to be reprogrammed by the technical representatives of the company from time to time.  Do not give up on the device if you are not having immediate success reprogramming frequently in the early phases is necessary for many people.  Many patients fail to take advantage of the reprogramming available and do not get maximum relief.  Remember that the spinal cord stimulator is a tool and for most people it will give significant relief and be worthwhile.  Nonetheless having realistic expectations of what the stimulator can do is important.  Always remember that the only patients that receive a spinal cord stimulator are patients in whom no other treatment was effective.  This treatment is reserved for the most difficult cases.

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