If you live with chronic pain or take care of someone who does, you know that it’s an everyday battle. And you’re not alone. Each year more than 100 million Americans are affected by chronic pain. Pain is the most common symptom for which patients seek medical attention. In addition to the physical and emotional suffering individuals endure, chronic pain has economic costs too — as high as $635 billion per year. This is greater than the annual costs of heart disease ($309 billion), cancer ($243 billion) and diabetes ($188 billion).
While the impact of chronic pain is great, there are numerous treatment approaches to help control and mask pain. Since it can be difficult to find the treatment that works best for you, it is important to know all of your options. One option that many people may not be aware of is spinal cord stimulation (SCS) therapy. To understand SCS, it is first important to understand how pain works. Pain is carried by electrical nerve impulses along the spinal cord to the brain. SCS masks these pain signals and replaces them with a gentle, tingling sensation using an implantable medical device. SCS has been used for more than 40 years, and the technology has evolved over the years to treat different types of pain.
A PACEMAKER FOR PAIN
The higher the number of contacts in an SCS system, the more control the patient has over each contact, making the treatment more personalized and targeted.SCS is like a pacemaker for pain and involves a device smaller than the size of a pocket watch, called an implantable pulse generator (IPG).
The IPG is connected to thin wires, or leads, that have stimulating contacts at the end. The IPG produces electrical pulses that travel through the contacts to the spinal cord to deliver pain-masking signals to the brain. Patients can control the strength of the electrical pulses using a remote control.
There are two types of pain, and the type of pain determines whether SCS may be an option. Nociceptive pain is pain that results from intense stimulation of peripheral nerve fibers called nociceptors and can be thought of as tissue pain. This is the type of pain you feel when you burn yourself.
SCS has been used for more than 40 years, and the technology has evolved over the years to treat different types of pain.
On the other hand, neuropathic pain arises as a direct consequence of a lesion or disease affecting the sensory system. This can be thought of as nerve pain. SCS may be a good option for this type of pain, since nerve-related chronic pain disorders may not respond well to advanced pain therapies.
SCS is approved by the FDA for the management of chronic pain of the back, trunk or limbs, and many people turn to SCS for pain that persists after back surgery, also known as failed back surgery syndrome. Multiple studies have shown that SCS is superior to standard medical management or re-operation in providing better pain control, reducing opioid pain medication and improving function.
THE PAIN TREATMENT PATH
It is important to understand that SCS would not be the first treatment considered for nerve-related pain. Patients are initially treated with medication management or physical therapy modalities, such as hot or cold therapy, transcutaneous nerve stimulation (TENS) or lidocaine or capsaicin patches. If these initial therapies are not successful, patients should see a board-certified pain medicine physician. These doctors have received an extra year of training in pain medicine in an accredited fellowship program and can evaluate patients for more specialized treatments, including SCS.
One of the advantages of SCS therapy is that patients can “test drive” an external version of the device to see if SCS is an effective treatment for their pain. This trial period usually lasts for about a week. If the patient and the doctor feel SCS helps reduce the pain and improve daily activities, the patient will move forward to full implantation of the system.
The implantation procedure usually involves outpatient surgery under local anesthesia with light to moderate sedation. An incision is made, through which the leads are placed and then anchored to the underlying tissue. In addition to the lead placement, the IPG is placed under the skin so that the entire system is contained by the soft tissues and is not visible externally. Patients can usually go home the same day as the procedure.
At a follow-up appointment with the physician, the incision is inspected and the spinal cord stimulator is reprogrammed to optimize pain coverage. A successful trial and subsequent implantation should provide improved pain relief and may also result in greater functional ability and a reduction of pain medication.
TECHNOLOGICAL ADVANCES CONTINUE TO IMPROVE SCS
SCS is not a new therapy, and like any technology, SCS devices have evolved over the years. Initial stimulators used only two contacts on a single lead, which limited effectiveness and the ability to address multiple areas of pain. However, the industry quickly developed systems with four contacts per lead, as well as dual leads, which were better able to target pain that affected both sides of the body or multiple regions in complex patterns.
Technology continues to improve, and today most systems have dual leads with eight contacts per lead for a total of 16 contacts, providing coverage for difficult to- treat pain such as thoracic pain from shingles. Other innovations have enabled clinicians to program the systems for maximum pain coverage, including the ability to very selectively control the delivery of energy. Recently, systems with more advanced programming and 32 contacts have become available. These systems cover a larger area of the spinal cord and, with the new programming, make it possible to target multiple areas of pain, especially when the pain is in different areas of the body. This has led to enhanced coverage for complex pain patterns, including low back pain.
Patients who have had unsuccessful trials of earlier versions of SCS should talk with their doctors about whether the newer systems may be able to meet their pain needs.
SCS is not the answer for every situation, but it is an option that may allow a person to reduce chronic pain, increase daily activities and reduce the need for potentially addictive pain medications. The most important point for people with chronic pain is that they should not be satisfied with therapies that do not address their symptoms fully. They should not be afraid to ask their doctors questions or get second opinions. Technological advances over recent decades are allowing SCS systems to bring more relief to more people who live with chronic pain.