Dr Thomas E Smith MBBS(Hons) MD FRCA FFPMRCA
Spinal cord stimulation provides dramatic pain relief for some people with severe chronic pain.
What is spinal cord stimulation?
Spinal cord stimulation is the delivery of patterns of electric charge to the rear (“dorsal”) part of the spinal cord to reduce chronic pain. The dorsal area of the spinal cord is where pain pathways run and where pain amplification takes place. Spinal cord stimulation decreases pain nerve conduction and turns the pain amplifier down. In the illustration below, pain messaging form the lower body shown in red is calmed by the spinal cord stimulation, so that only non pain messaging (blue) continues up to the brain.
A spinal cord stimulation system consists of:
- Leads (thin and flexible plastic wires with tiny metallic conducting wires inside and metal electrodes that release the electric stimulation)
- Implantable Pulse Generator (IPG) which combines a mini-computer and a battery within metal and plastic case. (Some kinds of systems use an external battery device)
- A remote controller – small and handheld
- In addition, many SCS systems are rechargeable and come with a recharging kit
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What sorts of pain can spinal cord stimulation help ?
- Chronic, moderate to severe pain that has not responded adequately to other therapies. Lifestyle approaches, physiotherapy, pain medicines, injections and other treatments will already have been considered and tried.
- The pain should be thought to have a strong neuropathic (nerve pain) element
Examples:
- Persisting back and leg pain after spinal surgery (commonest reason)
- Nerve pain after injury in surgery or other trauma in a limb or the trunk
- Nerve pain from damage caused by metabolic, infective, inflammatory and other causes. This includes diabetic neuropathy and post herpetic neuralgia (persisting pain after shingles)
- Complex Regional Pain Syndrome
- Severe headache conditions
- Limb pains due to lack of blood flow (vascular insufficiency)
- Persisting severe angina
- Some pelvic pains
- Some abdominal pains
- Sacral Nerve Stimulation may also be used to help some bladder and bowel control issues
Other related kinds of stimulation: