Director, Center for Rehabilitation of Pain Syndromes
University of California, Los Angeles
Los Angeles, California
Spinal cord stimulation (SCS) uses electrical impulses to block nerve signals and relieve chronic pain in patients for whom conservative treatments have failed. A number of randomized controlled studies in failed back surgery syndrome, complex regional pain syndrome, and other neuropathic pain disorders have demonstrated that SCS is a cost-effective treatment modality to decrease pain, improve function, and reduce analgesic consumption in appropriately selected patients. Before a permanent system is implanted, all patients should undergo a screening trial of SCS therapy to ensure that the device provides significant analgesia and helps the patient meet predefined goals. Potential risks include those related to surgery and misplacement of a needle in the spinal cord, although the latter is extremely unlikely for experienced practitioners using fluoroscopic guidance and live imaging. Additionally, a significant percentage of patients may experience lead migration such that the lead electrode no longer sits opposite the appropriate segments of the spinal cord, necessitating either reprogramming the pulse generator or surgical replacement of the lead. As with any treatment approach for patients with severe chronic pain, SCS should be one component of a multimodal functional restoration strategy that attempts to address all biologic and psychosocial aspects of the pain condition.
References
Manca A, Kumar K, Taylor RS, et al. Quality of life, resource consumption and costs of spinal cord stimulation versus conventional medical management in neuropathic pain patients with failed back surgery syndrome (PROCESS trial). Eur J Pain. 2008;12(8):1047-1058.
Taylor RS. Spinal cord stimulation in complex regional pain syndrome and refractory neuropathic back and leg pain/failed back surgery syndrome: results of a systematic review and meta-analysis. J Pain Symptom Manage. 2006;31(4 Suppl):S13-19.
North RB, Kidd DH, Farrokhi F, Piantadosi SA. Spinal cord stimulation versus repeated lumbosacral spine surgery for chronic pain: a randomized, controlled trial. Neurosurgery. 2005;56(1):98-106.
Kemler MA, Barendse GA, van Kleef M, et al. Spinal cord stimulation in patients with chronic reflex sympathetic dystrophy. N Engl J Med. 2000;343(9):618-624.
Spinal Cord Stimulation for Chronic Pain
Joshua P. Prager, MD, MS
Director, Center for Rehabilitation of Pain Syndromes
University of California, Los Angeles
Los Angeles, California
Spinal cord stimulation (SCS) uses electrical impulses to block nerve signals and relieve chronic pain in patients for whom conservative treatments have failed. A number of randomized controlled studies in failed back surgery syndrome, complex regional pain syndrome, and other neuropathic pain disorders have demonstrated that SCS is a cost-effective treatment modality to decrease pain, improve function, and reduce analgesic consumption in appropriately selected patients. Before a permanent system is implanted, all patients should undergo a screening trial of SCS therapy to ensure that the device provides significant analgesia and helps the patient meet predefined goals. Potential risks include those related to surgery and misplacement of a needle in the spinal cord, although the latter is extremely unlikely for experienced practitioners using fluoroscopic guidance and live imaging. Additionally, a significant percentage of patients may experience lead migration such that the lead electrode no longer sits opposite the appropriate segments of the spinal cord, necessitating either reprogramming the pulse generator or surgical replacement of the lead. As with any treatment approach for patients with severe chronic pain, SCS should be one component of a multimodal functional restoration strategy that attempts to address all biologic and psychosocial aspects of the pain condition.
References