Waiting for a rock concert to begin, 25-year old NICOLE ADDIS felt fit, happy and excited to be enjoying an evening out after the birth of her daughter two months prior. As the music started, a crowd rushed in behind Addis, pushing her to the floor.

“I heard a sickening pop sound,” recalls Addis. “Then my foot immediately started to throb and swell. I only stayed for two songs before the pain got so severe I had to leave.”

X-rays in the ER showed no broken bones, but after a week on the couch, Addis was still in pain. She was anxious to resume training for a half-marathon — halfway to her lifelong goal of completing a full marathon — but when the pain continued to be too agonizing for her to walk, Addis saw a podiatrist (foot doctor) who thought she might have extensive tendon damage.

After steroid injections, physical therapy, pain medication, experimental treatments and two surgeries, Addis’s pain was worse than after the original injury. “I was so disheartened,” says Addis. “I had intense burning pain and extreme sensitivity to touch. Even exposure to air conditioning was excruciating.”

It took a visit to a pain management specialist to diagnose the problem as complex regional pain syndrome (CRPS). The doctor suggested a screening trial for spinal cord stimulation, also known as neurostimulation therapy. Spinal cord stimulation is proven effective for managing certain types of chronic pain. It uses a surgically placed device to deliver mild electrical signals to the area near the spine. Spinal cord stimulation provides pain relief by disrupting the pain signals traveling between the spinal cord and the brain. Instead of pain, patients feel a tingling sensation where the pain used to be.

David Provenzano, MD, works in the area of pain management. Although not Nicole’s physician, Dr. Provenzano has treated many patients with spinal cord stimulation, including patients with CRPS. “With spinal cord stimulation,” explains Dr. Provenzano, “we want to not only control pain, but also help improve function, so patients can do the things they want to do, every day.”

Unlike many other treatments, spinal cord stimulation doesn’t require medication. A person doesn’t have to wait for medications to take effect — the stimulation is instantaneous. And often, spinal cord stimulation therapy allows a person to decrease or eliminate medication use so there are fewer or no drug side effects like fatigue or nausea to manage. Dr. Provenzano adds, “Spinal cord stimulation is one of the few therapies that can be tried before committing to the long-term therapy. You don’t have to guess if the treatment might work for you.”

When Addis researched spinal cord stimulation, her heart sank. She knew her podiatrist wanted her to have an MRI to rule out tendon damage, but she had read that the therapy required an implantable device that wouldn’t be compatible with MRIs. The alternative was exploratory surgery, which Addis wanted to avoid.

Now more than ever, MRI is the go-to scan for diagnosing problems with soft tissue, like muscles and nerves. MRI is one of the most commonly performed tests in the world, and has been referred to as the “gold standard” for pain diagnosis.

Addis was desperate for pain relief. While waiting to see if her insurance would cover an MRI scan, Addis agreed to have the trial to see if spinal cord stimulation might work for her. “My hope was for the therapy to just take the edge off the pain,” remarks Addis. “Just enough so I could get to the back of the grocery store without resting. The trial lasted one week and it was the first time in four years that CRPS was not the focus of my thoughts! I knew I wanted spinal cord stimulation right away.”

stim2Managing Pain AND Protecting Future MRI Options

The morning Addis was scheduled for her implant, she was surprised to find out that she would be the first one in her state to receive a newly released neurostimulation system that allows safe access* to an MRI scan on any part of her body. (*Under specific conditions and requires SureScan® implantable neurostimulator and Vectris® leads.) If a system doesn’t have the new MRI technology, it may have to be surgically removed before a person can be scanned safely.

With this innovative technology, Addis could manage her pain and protect future MRI options. “Getting that high-tech neurostimulator was a turn-around for me,” recalls Addis. “Besides a major reduction in pain, I was able to have an MRI which showed no tendon damage! I avoided an unnecessary surgery and got the okay to run again.”

Everyone responds to pain and pain management differently. Not everyone will respond to spinal cord stimulation as Addis did. It’s important for people who are living with chronic pain to research their options and prepare themselves with information. Partnership be-tween patients and physicians is the most effective wayto make decisions about the pain therapy that will be right for them.

stim3“Adaptive” Stimulation—Set It AND Forget It

Addis was surprised to find out that only one company, Medtronic, offers the new MRI technology and another unique feature called adaptive stimulation. Throughout each day, a person changes positions repeatedly — from sitting to lying down, from lying down to standing up, from standing to walking. For someone receiving spinal cord stimulation, a stimulation level that blocks pain when standing may be uncomfortable when lying down. As a result, without adaptive stimulation, frequent adjustments must be made with the hand-held programmer to keep things comfortable.

“They didn’t turn on the adaptive stimulation feature for the first three weeks after surgery,” states Addis. “Whenever I stood up or sat down, I had to turn the stimulation up or down with my remote programmer. It was getting a little annoying.” Addis adds, “With this adaptive stimulation turned on, I hardly ever touch my remote. Now I don’t think about pain or adjusting the stimulation. I can just live my life.”

Today, pain management options reach well beyond pills, injections and surgeries, which don’t always result in long-term pain relief. Better diagnosis and better understanding of what causes pain have led to advances in treatments, including spinal cord stimulation.

To achieve both sustained pain relief and improved function, Dr. Provenzano looks to spinal cord stimulation therapy.“ Fortunately for patients, recent advances in one stimulation device make the therapy even easier to manage their pain,” explains Dr. Provenzano. “They have access to MRI advanced diagnostic care and they have adaptive stimulation, which means patients can make significantly fewer adjustments to their stimulation throughout the day.”

New Technologies, New Possibilities

Today Addis is well into her marathon training, working full-time and enjoying activities with her two daughters. She has advice for anyone who is considering spinal cord stimulation. “Anyone dealing with chronic pain and feeling hopeless should at least do the trial,” suggests Addis. “It’ll give you a good indication of your chance for successful therapy. And I’d definitely get the most advanced device, one that wouldn’t limit my access to MRI scans and has adaptive stimulation.” {PP}

This educational content was provided by Medtronic.