Spinal Cord Stimulation for Chronic Back and Neck Pain
By Neel Mehta, MD
People whose back or neck pain has not been relieved by back surgery or
other treatments may have another option to consider: spinal cord stimulation.
Around the world, some 14,000 patients undergo spinal cord stimulator implants
each year. Spinal cord stimulation (SCS) delivers mild electrical stimulation
to nerves along the spinal column, modifying or blocking nerve activity
in a non-medicinal way to minimize the sensation of pain reaching the brain.
Spinal cord stimulation was first used to treat pain in 1967. Spinal cord
stimulation was approved by the Food and Drug Administration (FDA) in
1989 to relieve pain from nerve damage in the trunk, arms, or legs, and
now accounts for about 90 percent of all neuromodulation treatments. That
number is expected to grow to manage chronic disease states as the population
ages and as spinal cord stimulation is expanded to treat other diseases.
Spinal cord stimulation, also called neurostimulation, directs mild electrical
pulses to interfere with pain messages reaching the brain. A small device
implanted near the spine generates these pulses. The implanted generator
used in spinal cord stimulation has similarities to a cardiac pacemaker,
leading some to call the device a pacemaker for pain.
This article covers how spinal cord stimulation works and who is most likely
to benefit from the therapy.
Growing Interest in Spinal Cord Stimulation
Spinal cord stimulation has been used for decades, and is being recommended
for an increasing number of conditions. Failed back surgery syndrome,
cervical and lumbar radiculitis, neuropathy, and complex regional pain
syndrome are some conditions that may be helped by the therapy.
Smaller devices have made implantation less invasive, and innovations—such
as devices that are compatible with magnetic resonance imaging (MRI)—have
expanded the number of people likely to consider the therapy.
In addition, nationwide efforts to reduce reliance on opioid pain medications
are bringing renewed interest to a range of pain-relief treatments that
do not involve medications—including spinal cord stimulation.
Trial Period Offers an Unusual Option
Unlike most treatments requiring surgery, spinal cord stimulation can be
tried for a short time before a person commits to having the implant or
having any lasting negative effects. The trial period is part of a two-step
screening process to select those most likely to benefit. Should a patient
not want the trial anymore, the lead is pulled out in the office, and
a small bandage is applied—a simple, painless process.
Careful screening is needed because spinal cord stimulation does not work
for everyone. Most people who are good candidates for the therapy, however,
report at least a 50% reduction in pain, as well as significant improvement
in daily functioning.1
Some people are also able to take fewer opioid medications (painkillers)
after they start spinal cord stimulation.
Peripheral Nerve Field Stimulation Uses Similar Process
Spinal cord stimulation is one of two related forms of electrical stimulation
commonly used to treat chronic pain. The other, peripheral nerve field
stimulation, is similar, but the devices directing the electrical pulses
are placed just under the skin in an area near the nerves involved in pain.
It is possible to have both spinal cord stimulation and perihperal nerve
field therapy in combination for pain treatment.