Treatment of pain with neurostimulation
Neurostimulation is an advanced therapy used to treat certain types of chronic pain and neurological disorders. The goal of neurostimulation is to superimpose a pleasant pulsed stimulation (buzzing or tingling) over a patient’s normal pain pattern. This confuses the brain and changes the interpretation of pain, resulting in pain relief.
What is a spinal cord stimulator?
A Spinal Cord Simulator (SCS) is an implantable system used for neurostimulation. It consists of a lead (a set of electrodes used to deliver electrical stimulations), an extension (a wire to connect the power source to the lead), and a generator (a battery powered source for the stimulation). When implanted, the generator transmits electrical impulses to the positive and negative electrodes on the lead producing the buzzing or tingling sensation and interrupts the pain message before it gets to the brain.
How is the neurostimulator implanted?
The implantation of a neurostimulation system is usually a two-phase, outpatient, minor surgical procedure. It consists of a trial phase and a permanent placement phase. If the trial phase is successful and the patient experiences at least 50% pain relief, the permanent placement is scheduled.
A trial consists of the physician placing the lead into the epidural space over the nerves believed to be producing the pain.
The patient receives a local anesthetic and light sedation to allow them to verbally assist the physician with proper placement of the leads. Once inserted, the leads are connected to an external battery. The patient then goes home and monitors their pain relief. If the trial is successful, the patient is scheduled for permanent placement of the system. This involves placement of the lead, connecting and tunneling the extension under the skin to the implanted generator.
Patient selection criteria
Neurostimulation is not for everyone. Careful patient selection is necessary. This treatment is typically used for nerve pain described as burning, shooting, sharp or electrical-like sensations. Before the trial, patients must attend a class that reviews the procedure.
Advantages & disadvantages
Increased pain control is a major advantage. The patient has control over the device allowing for adjustment in stimulation as needed. The use of oral pain medication can be eliminated or reduced in most cases. This treatment is most effective when combined with other methods to control pain which may include physical therapy, medication management, weight loss, smoking cessation and other recommended interventions.
Like all medical devices, the neurostimulator can potentially malfunction. There is also the possibility of lead migration. As the trial and implantation is a surgical procedure, the risks include all of the potential risks associated with surgery, including infection, nerve damage and rarely death.