Neurostimulation for back pain

Treatments

Spinal Column and Peripheral Nerve Stimulator

Spinal Cord Stimulators

Patients who suffer from nerve pain in the limbs, failed back surgery syndrome, complex regional pain syndrome, peripheral neuropathy, chronic back pain, peripheral vascular disease and sometimes, post shingles pain, may be candidates for spinal cord stimulation therapy.

Spinal cord stimulation therapy can provide pain relief and improve limb mobility and quality of life. The device sends low level electrical signals through the electrode/lead to the posterior, sensory aspect of the spinal cord, to block the transmission of pain signals to the brain. Many patients describe the stimulation as a tingling sensation. This tingling sensation is programmed to overlap with the areas of pain, thereby blocking it. The spinal cord stimulator can be programmed so that no tingling is felt at all, but still the pain message is blocked.

A psychological evaluation by a psychologist or psychiatrist is required by insurance companies to assure the patient has a good understanding of the procedure and to determine if it is an appropriate option for them from a psychological standpoint.

Temporary Stimulator

Before the spinal cord stimulation system is permanently implanted, a temporary trial is done to determine if sufficient pain relief can be achieved. A temporary stimulator lead (a thin wire) is placed through the skin to the epidural space. It is connected to an external battery-operated stimulator and programmed to provide stimulation (tingling) at the painful areas of the body. The electrode (s) may remain in place for approximately 3-5 days to determine if significant pain relief is achieved. Once the trial is completed, the lead is easily and painlessly removed.

Permanent Stimulator

A permanent spinal cord system is surgically placed at least 2 weeks later to minimize risk of infection. This procedure involves inserting a new lead similarly to the trial through an incision in the skin. A battery/generator is placed under the skin in the buttock or abdominal area and connected to the lead in the back under the skin. Once the system is implanted, the stimulation system is programmed to match the painful area and the stimulation is adjusted to provide the optimal pain relief. The procedure is carried out on an outpatient basis.
There can be some pain and swelling at the incision site, which is normal and typically resolves in a few days. Short term pain medications are usually provided for pain at the incision sites. Recovery is relatively quick and patients can begin light exercise a few days following the procedure. However, lifting, bending, stretching and twisting should be avoided immediately following the implantation for up to a few months, depending on the type of electrode placed.
Complications of the procedure are rare, but include: infection, bleeding, spinal fluid leakage, paralysis, allergic reaction and nerve damage. Other risks include movement of a lead or less commonly malfunction of a lead, requiring surgical intervention to correct. If a lead does move, often the system can be reprogrammed to account for the lead. To prevent movement of the lead, a spine surgeon can place a special paddle shaped lead rather than the wire at the time of the permanent placement. Patients with spinal cord stimulators for chronic nerve pain in a limb, report a 60-80% decrease in pain following the procedure, improved function of the limb, and less reliance of oral pain medicines.

Peripheral Nerve Stimulator

Peripheral nerve stimulation (PNS) is an outpatient procedure wherein a small electrical device is implanted near a damaged nerve to interrupt pain signals. The peripheral nerves are the nerves found outside of the brain and spinal cord. It is similar in technology to a spinal cord stimulator but may have an external power source rather than an implanted power source.

Before placing a permanent implant, your physician will perform an image guided nerve block to diagnose the nerve that is causing the pain. A psychological evaluation by a psychologist or psychiatrist is required by insurance companies before a peripheral nerve stimulator trial to assure the patient has a good understanding of the procedure and to determine if it is an appropriate option for them from a psychological standpoint.

Then, you and your care team will go through a peripheral nerve stimulator trial to ensure the implant will produce pain relief. The electrode (s) may remain in place for approximately 3-7 days to determine if significant pain relief is achieved.If this proves successful, a permanent implant will be provided. The device is small enough that it can be placed under the skin. You will be provided with a remote control that can turn the device on or off as needed.

When pain flares up, the device works by sending small electrical signals out to interrupt the nerve signals. While the stimulation can be used continuously, patients often find that the pain relief lasts for hours after turning it off and so can use the stimulation on an as needed basis. Many have had this procedure and achieved excellent pain relief. PNS has a very high success rate and the results are almost immediate. If the device malfunctions, it is a minor surgical procedure to remove it. The implant is placed just beneath the skin, making implantation and removal a minimally invasive process.

Treatments

non-Surgical Treatments for Back Pain

Short Term: Medications, Trigger Point Injections, Steroid injections

Prescription Back Braces

Radio Frequency Ablation

Orthobiological treatments

Spinal Column and Peripheral Nerve Stimulator

Kyphoplasty and Sacroplasty for compression fractures

MILD® Procedure for Lumbar Spinal Stenosis

Intradisc Fibrin (Discseel®)

Stem Cell Therapy