If you have been looking for chronic pain relief and haven’t found it with more conservative treatments, chances are good you’ve considered a spinal cord stimulator. This device can help you get back to pain-free daily activities. It can also bring up a lot of questions, though. It’s always good to talk to your doctor for specific questions relating to your pain condition, but Arizona Pain can help. Whether you are already living with a spinal cord stimulator or still weighing your options, here’s answers to some of your most frequently asked questions about this pain management approach.

What’s it like living with a spinal cord stimulator?

Living with a spinal cord stimulator for many people means living with less than half the pain they experienced in the past. That’s the short answer, but it holds true for the majority of patients who are good candidates for spinal cord stimulation. People living with chronic pain report that they are able to get back to their normal lives, with less pain and more mobility.

A spinal cord stimulator is an implanted device that is controlled outside the body by the patient. A remote with an antenna controls the level of stimulation that interrupts pain signals. This means that when it is successful, the patient can resume the majority of their regular activities without worrying about chronic pain. While it is unclear exactly how spinal cord stimulators work to relieve pain, it seems to be a combination of mechanisms at work in the body and the brain.

Living with a spinal cord stimulator also means in many cases that patients take fewer opioids and other pain medications. Less medication, less pain, more of the life you want to lead – these are all possible with a spinal cord stimulator.

Am I a good candidate for SCS? 

Spinal cord stimulators are not for just any type or severity of pain. Typically, patients who are researching living with spinal cord stimulators have traveled the long road of more conservative treatments without success.

Because it involves a two-stage, surgical process, however, spinal cord stimulation is not a first-line treatment of chronic pain for the vast majority of people. Many people first try to resolve their pain with physical therapy, activity modification, or chiropractic care. If those and other minimally-invasive interventions don’t work, then your doctor may recommend a spinal cord stimulator.

Once it becomes apparent that you need a more interventional approach, the first step is to have a trial stimulator implanted. If this relieves your pain after a set period of time, then you can talk to your doctor about moving to a more permanent implant.

The most common conditions treated with spinal cord simulation include:

• Back pain
• Failed back surgery syndrome
• Inflammation of the membrane that covers the brain and spinal cord (arachnoiditis)
• Angina
• Spinal cord injuries
• Nerve pain (e.g., diabetic neuropathy and cancer-related neuropathy from radiation, surgery, or chemotherapy)
• Peripheral vascular disease
• Complex regional pain syndrome
• Pain after an amputation
• Visceral abdominal pain and perineal pain

That said, even if you have tried other treatments without relief, a spinal cord stimulator may not be for you if you meet the following criteria:

• You are pregnant
• Your spinal cord stimulator trial didn’t relieve your pain
• You are not able to operate your spinal cord stimulator system
• You have a high risk of surgical complications

Each patient and their pain is very different. The best way to determine if you’re a good candidate for spinal cord stimulation is to talk to your doctor about all of your options. Not only will they have a good awareness of your treatment history, but they will also be able to recommend FDA-approved devices for your specific pain condition.

What are the major types of spinal cord stimulators, and how do they work?

There are three main types of spinal cord stimulators:

1. Traditional spinal cord stimulators
2. Burst spinal cord stimulators
3. High frequency spinal cord stimulators

Within these categories, spinal cord stimulators also offer different battery options.

• Implantable pulse generator (IPG): This battery must be replaced, which means surgery to remove the device is required
• Rechargeable implantable pulse generator: Works like a conventional IPG but the device does not have to be removed to swap out a dead battery
• Radiofrequency stimulator: This device is less common, but it uses a battery outside the body

Let’s look at each of these types in more detail.

Traditional spinal cord stimulators

A traditional spinal cord stimulator is by far the most common type of device to treat pain.

This type produces a gentle tingling or buzzing sensation (referred to as paresthesia). This paresthesia replaces the pain sensations and provides a distraction from any pain that remains.

Burst spinal cord stimulators

These low-frequency spinal cord stimulators also use electrical impulses delivered in short bursts (rather than in a constant stream).

This mimics the way in which nerves communicate naturally and can be good for patients who have pain in one single area.

High frequency spinal cord stimulators

High frequency spinal cord stimulators use electrical impulses of 1 kHz and above to reduce pain without tingling sensations.

Some patients and doctors prefer high frequency spinal cord stimulation because it requires less intense stimulation to provide relief on the very first day, without the paresthesia that some patients find uncomfortable.

How do I operate my spinal cord stimulator? 

Your spinal cord stimulator settings control the frequency and intensity of electrical impulses as well as the area that the impulses cover. Your doctor will set the initial pulse, but you can change it with a handheld controller as needed. You can typically also program your stimulator to different levels at different points in the day. For example, if you need less intensity at night, there’s a setting you can program for that.

Keep your controller with you to ensure the proper levels of relief no matter where you go and what you’re doing. Your doctor will walk you through the specific programming procedures and make sure you’re comfortable with the device. This ensures the best level of pain relief.

How do I care for my stimulator?

Caring for your spinal cord stimulator is about caring for your remote, charging your device’s battery correctly, and keeping track of any changes in your pain levels and the sensations from the stimulator.

Keep your remote in a temperate environment (not colder than 50° and not warmer than 104°). Clean as needed with a soft cloth – no abrasives needed.

Rechargeable spinal cord stimulator batteries have specific instructions depending on the manufacturer, so pay attention to the manual’s instructions. Reach out to your doctor if you need assistance with charging. For batteries that need to be surgically changed, regular visits to your doctor can help keep track of the timeframe for this.

As to the proper function of the device, it helps to keep track of pain levels and relief in a pain journal. This helps you see what activities affect your pain, which levels of electrical impulse work best for you, and if anything changes. Share these notes with your doctor for finetuning your pain management plan.

How do I change my spinal cord stimulator settings?

Each spinal cord stimulator’s settings can be changed using the remote.

Your doctor will initially set your level of stimulation (plus its frequency and intensity). Later, you can change these as needed. Follow your device’s instruction manual for specific steps to do this, and reach out to your doctor if you have any difficulties.

How to turn off spinal cord stimulator?

Your spinal cord stimulator is turned off and on with the remote control. Each device is different, but they all come with detailed instructions.

Your doctor will go over these with you and answer any questions specific to your device.

Are there any travel restrictions with a spinal cord stimulator? 

There are some things to be aware of when traveling with an implanted spinal cord stimulator. Your spinal cord stimulator will be detected by X-ray machines at the airport. Your doctor will provide you with a medical ID card that authorizes and explains the device.

Additionally, driving is not recommended when your spinal cord stimulator is powered on. Although the electrical impulses are not painful, they can be distracting when driving.

Some of the high frequency spinal cord stimulators are safe to drive with while powered on, as they provide a level current of electrical impulse that is not startling. If driving is a major part of your life, talk to your doctor about finding the stimulator that works for you.

How do I stay safe with a spinal cord stimulator? 

Spinal cord stimulators should not cause pain or discomfort, but a sudden change in position can sometimes cause the sensation of the electrical impulse to intensify. Avoid changing position suddenly to prevent unwanted intensity.

Additionally, avoid activities that lead to excessive pressure in the area of the stimulator and leads. This protects the device from damage and ensures a comfortable level of stimulation.

As noted above, turn off your device when driving, but feel free to keep it active as a passenger. As a general rule, in situations where you might be dangerously distracted by the electrical pulses, it’s best to keep it switched off. Likewise, if the electrical impulses become uncomfortable, turn your device off and give your doctor a call.

Can I get an MRI with a spinal cord stimulator?

Some spinal cord stimulators can cause injury with an MRI, but there are some that are perfectly safe.

Make sure all of your healthcare providers are aware of your specific spinal cord stimulator. They also need to know its location before getting an MRI.

Can you go swimming with a spinal cord stimulator?

During your spinal cord stimulator trial, you may not swim, take a bath, or otherwise get your back wet. Good news, though: this is temporary.

When your permanent spinal cord stimulator is in place and the sutures are healed, swimming is okay.

Can you see the spinal cord stimulator when it’s implanted?

Some people report that they can feel the device when they apply light pressure with their fingers. The device itself is not generally visible.

How often do spinal cord stimulators need to be replaced?

The lifespan of a spinal cord stimulator is more about the battery than the device itself.

Those devices with non-rechargeable batteries generally need to be surgically replaced every two to five years. If you have a rechargeable device, the lifespan is ten years or more. In this case, you need to remember to charge your battery appropriately.

Learn more about spinal cord stimulation 

Chronic pain can feel like one long struggle, but it doesn’t have to be that way. Even when you’ve tried many options over the years, there is still hope. Spinal cord stimulation may be the solution to your intractable pain.

Living with a spinal cord stimulator means potentially less pain, less medication, and more of the life you want to be living. If you have questions and want to find out how a spinal cord stimulator can help you get your life back, Arizona Pain can help. Get in touch today!

Pain is a complex thing and it is the number one reason why people in the U.S. search for help via the healthcare system. According to the U.S. Department of Health and Human Services, chronic pain is the most common cause of long-term disability. It can also be a barrier to treatment, accounts for a large portion of healthcare costs, and is the biggest reason for work absenteeism. But what do you do when your chronic pain doesn’t respond to standard treatments such as medications, steroid injections, or physical therapy? One approach is called spinal cord stimulation (SCS).

What is spinal cord stimulation?

Spinal cord stimulation has been around for about four decades. A permanent spinal cord stimulator device is made up of small, thin wires that have electrical leads on the end. These are placed along the spinal column. The wires are capable of delivering electrical pulses to the epidural space via a power source called an internal pulse generator. This can help relieve pain in some patients.

This treatment approach focuses on treating neuropathic pain. This is pain that develops as a result of damage to the central or peripheral nervous system. This is a major reason why spinal cord stimulation is so useful for patients of failed back surgeries. It can help alleviate pain even when the underlying cause has yet to be identified.

How does spinal cord stimulation work?

Spinal cord stimulation can be very effective in reducing overall pain, especially that from failed back surgery. This is likely because the electric charges produced by this medical device mimic the body’s natural neurological system. This has the effect of interrupting some of the pain signals being created by the body before they can reach the brain.

The spinal cord device comes with an exterior remote that allows the patient to send pain-blocking signals to the spinal cord as desired. This gives the doctor and patient some degree of control of these signals. The machine can be adjusted as needed to provide different levels of relief and can be turned on and off as the patient would like.

Spinal cord stimulation effectiveness is heavily dependent on the person, so this treatment option always starts out with a brief trial period. The trial usually lasts between three and 15 days to see if a patient will actually find relief from the device. A reduction of pain by at least 50% from the baseline with no major complications is required to consider a trial successful.

The science behind spinal cord stimulation

There has been quite a bit of research done on the effectiveness of spinal cord stimulation in the last 40 years. Much of it has shown that these devices are safe. It also shows that they are very good at managing certain kinds of pain. While there are many benefits to this treatment, there are still some complications inherent to the procedure.

One study, conducted by Dr. Young Hoon Jeon, MD, showed that SCS greatly improves the quality of life, daily function, and overall satisfaction of patients that undergo this treatment. It also revealed that most complications in this procedure are related to hardware issues. However, these issues were generally minor if the operation was overseen by someone with the proper expertise.

In another study, by KJ Burchiel et al, all 219 patients underwent a trial period for a SCS device of which only 182 patients obtained a permanent version. Of those who responded after one year, all of the pain and quality of life measurements used were significantly higher during the treatment year. Furthermore, complications were shown only to affect 17% of those patients. Overall, the study showed that spinal cord stimulation is a great pain management tool. It also has significant value in treating chronic pain in the lower back and extremities with minimal complications.

Spinal cord stimulation for failed back pain patients

A literature review was conducted by Michael Frey et al to exam the evidence and to evaluate the effectiveness of spinal cord stimulation, specifically relating to failed back surgery syndrome. This was measured by first measuring the pain relief provided in these studies. Then they took into account secondary measures that included functional status, psychological status, reduction of opioid medications, and the patient’s ability to return to work after the procedure. Overall, it was found that the evidence showing the effectiveness of SCS in relieving chronic pain from failed back surgery syndrome was obtained from well-designed trials. Further, case-controlled analytics studies backed the efficacy of spine cord stimulation on a long-term basis.

What is it like to have a spinal cord stimulator?

The procedure itself takes anywhere between an hour and 90 minutes to complete. During that, the pain doctor will place the leads near the spinal column with a needle. If the treatment is deemed successful, a more permanent spinal cord stimulation device is surgically implanted.

With spinal cord stimulation, you will first use a trial device. It comes with a preset program for the temporary electrical generator that you wear on your waist like a cell phone. If spinal cord stimulation is successful, a tiny electrical generator is implanted in the abdomen or upper buttocks via a small incision. The incision for the generator is so small that it will not be visible on the body. It will not inhibit any other activities, such as swimming.

The generator only requires new batteries every two to five years depending on use.

Risks of spinal cord stimulation

This treatment option is considered safe and easily reversible. However, there are a few reported complications to be aware of, although serious complications are very rare.

As with all surgeries, there is a risk for infection. Implanting a spinal cord stimulator also carries with it the possibility of scar tissue to build up around the wires and generator.

Other issues that can occur include:

• Migration of the electrode
• Unpleasant stimulation of the chest and ribs
• Cerebral spinal fluid leak
• Numbness or paralysis
• Hardware failure
• Allergic reaction
• Pain at the incision site

Have you ever received spinal cord stimulation for failed back surgery?

Read About Arizona Pain Spinal Cord Stimulation Therapy

Arizona Pain Spinal Cord Stimulation Therapy is an exciting new treatment for patients! Arizona’s leading pain management practice announces new cutting-edge treatment option for chronic back and leg pain patients in Arizona

Arizona Pain (arizonapain.com) is dedicated to bringing cutting-edge chronic pain treatments to Arizona residents who need them. As part of that commitment, Arizona Pain is excited to announce that it is the first medical practice in the state to offer an innovative new therapy for chronic back pain and leg pain.

The Senza® SCS system, which delivers Nevro’s proprietary HF10 therapy (Nevro Corporation, Menlo Park, CA), is a recently FDA-approved spinal cord stimulator (SCS) that has demonstrated superior results compared to traditional SCS for the treatment of chronic back and leg pain.

100 million people in the U.S. suffer from a chronic pain condition. Chronic pain is the primary cause of adult disability in the U.S. Chronic back pain, specifically, is one of the most common reasons for missed time from work, with 80% of adults suffering from back pain at some point in their lives. There are a variety of treatment options for chronic pain, ranging from medication to surgery to interventional treatments, like spinal cord stimulation.

Traditional spinal cord stimulator therapy typically delivers electrical pulses that attempt to “mask” a patient’s sensation of pain by covering the area with paresthesias (tingling, pins-and-needles, and prickling sensations). HF10 therapy, on the other hand, relieves pain without paresthesias by using a higher frequency of electrical pulses, along with additional proprietary factors.

According to the FDA, HF10 therapy:

• Was found to have superior response rates and pain relief versus traditional SCS therapy in patients with back and leg pain
• Is approved for use without patient restrictions on motor vehicle operation while receiving therapy
• Is the only SCS therapy indicated to provide pain relief without paresthesias

Tory L. McJunkin, MD is the medical director of Arizona Pain and explains:

“Our practice is committed to finding the least invasive and most effective treatments to help those who suffer from chronic pain. HF10 therapy is an exciting cutting-edge treatment option for many who have failed other treatments. Our practice’s purpose is to provide hope and restore life for those who desperately need it.”

Arizona Pain is proud to provide this innovative new treatment option to chronic pain patients in Arizona.

About Arizona Pain

Arizona Pain was founded on a single premise—provide world-class care for those in our community, with a focus on research and cutting-edge treatment plans. For us, world-class care means providing the comprehensive and innovative treatments that we would want for our own mom or dad. It’s that simple.

Senza, HF10, Nevro, and the Nevro logo are trademarks of Nevro Corp.

Chronic pain sufferers looking for new options to manage their conditions might consider implantable devices. Researchers are working to update these devices to make them even more helpful in the fight against chronic pain. New technology has made them not only more flexible, but also more convenient, operating from wireless technology and without a bulky power source.

Implantable devices are generally considered good options for patients who have experienced little success with other conventional treatments such as physical therapy or steroid injections. The technology harnesses the power of gentle electrical currents to disrupt nerves as they send messages of pain to the brain.

The devices have been around since the 1970s, but the latest generation harnesses an unexpected, but ubiquitous source to diminish pain: light. Recent studies advancing the next generation of implantable devices are part of the emerging field of optogenetics, which studies the ability to control neurons with light.

So far, studies have mostly been conducted in animals, but researchers are full of hope about the technology’s potential to offer pain patients new hope and improved quality of life.

Rapidly advancing technology in the field of implantable devices is making them more effective and easier to use.

The devices have until now been rigid and needed to be anchored to a bone inside the body. But newer devices have more flexibility, and researchers at Washington University School of Medicine say this malleability allows the devices to be implanted in parts of the body that move. They could eventually reduce pain in areas like the stomach, bladder, and other organs without nearby bones.

The devices are also wireless and can operate without batteries, making them much more convenient than older devices that needed to be attached to a power source.

Eventually, researchers hope these flexible implantable devices will be able to essentially flip a switch and shut off pain signals before they reach the brain. Study co-author Dr. Robert Gereau says:

“When we’re studying neurons in the spinal cord or in other areas outside of the central nervous system, we need stretchable implants that don’t require anchoring.”

Instead of being anchored to the bone, new implantable devices are held in place with sutures. They contain special microLED lights that trigger certain nerve cells in order to diminish pain. This finding offers hope for patients whose conditions haven’t been responsive to other, more commonly used therapies, researchers said.

The Washington research came on the heels of a victory just months earlier. In August 2015, researchers affiliated with Stanford University developed the world’s first wireless, implantable device that used light as a means of controlling nerves and the brain, reports Medical News Today. The device was impossibly small—about the size of a peppercorn—and communicated radio waves through the study mouse’s body.

The constraint is that the device only works on nerves that contain light-sensitive proteins. However, this field’s rapid advancements offer great hope for the future of implantable devices and the patients who need pain relief.

Implantable devices could fill a void in the pain management world, where many patients have few options.

With the dangers of painkillers becoming increasingly well known, both patients and doctors are searching for healthier alternatives. Some experts predict that implantable devices will become more popular for that reason. The technology has existed for a long time, but hasn’t been very popular, partially because it can be quite expensive.

Fortunately, some medical trials are available, providing qualified patients access to the implantable devices at a significant discount, or in some cases, for free, reports ABC News.

How are implantable devices used?

One common method of harnessing the energy of implantable devices is with a technique called spinal cord stimulation. This reversible, safe, and effective treatment is particularly effective for nerve pain, also known as neuropathic pain.

This nerve pain may develop from lesions in the nervous system that result in pain, according to Pain Doctor. With spinal cord stimulation, the implantable device is inserted near the spinal cord. Gentle electrical currents are released into the epidural space, interfering with pain signals so they don’t reach the brain.

Patients have control over the electrical impulses through a hand-held controller.

Spinal cord stimulation has a long history. The first instance of its successful use in the epidural space dates back to the early 1970s. Scientists still aren’t sure the underlying mechanics that make this treatment so effective, but many patients are able to experience lasting relief.

During the decades since that first implantable device, science has made great strides, both in understanding pain pathways and improving technology. These advancements have made the devices easier to use and more effective, while also improving the actual process used.

How does the process of getting an implantable device work?

The first step for patients is to visit a doctor for an evaluation. Patients first receive a temporary electrode in the skin to test the electrical stimulation’s effectiveness before committing to the full implant.

The devices are controlled by a hand-held controller that adjusts the electrical current’s pulse strength and frequency. Your doctor helps you determine the adequate schedule for receiving the electrical current.

After a successful trial run, patients can opt to receive a permanent device that’s implanted beneath the skin. In addition to the implantable device, the doctor inserts small coated wires and connects them to nerves or the spinal canal. These wires carry the electrical pulses.

A common schedule is to receive the stimulation in one or two-hour sessions, up to four times each day, according to WebMD. However, this varies by patient and should be thoroughly discussed to determine dosing that works for each individual person.

The surgery typically requires only local anesthesia, and involves a small incision.

Have you ever considered an implantable device to reduce chronic pain?

FROM THE LAB
By Ted Swing, Ph.D

The loss of a leg due to an accident or other cause can pose a number of challenges, from the immediate pain to walking again with prosthesis. Such injuries can also cause severe chronic pain, potentially lasting for years. These patients may have their chronic pain managed with medications, injections, or ablations of the affected nerves, which are often effective in reducing this pain.

We are taking part in a new study for those patients with a leg amputation who continue to have severe chronic pain despite such treatments. This study may offer them another option for pain relief.

We believe that neurostimulation devices are one of the most promising frontiers in chronic pain management, as they offer the potential for significant pain relief, often with fewer risks and side effects than many medications and surgical procedures. The most widely used of these devices are spinal cord stimulators. These devices deliver pulses of mild electrical stimulation to the spinal cord to disrupt and replace the pain in an affected area. Neuros Medical has developed a new type of neurostimulation device – the Altius® system – and they are testing it with patients who have lost a lower limb.

The Altius is different from most neurostimulation devices in several ways. Rather than placing the lead that delivers stimulation in the spine, the Altius system uses a cuff electrode that is implanted around the sciatic nerve. This is a large nerve running into the thigh, branching off to gather sensations (including pain) from the whole leg. The Altius system also delivers stimulation much faster than most neurostimulation devices — thousands of times every second. This rate of stimulation is so rapid that patients don’t even feel the mild tingling sensation that normally accompanies stimulation, yet some early studies have found it to be effective in relieving pain. In fact, this relief seems to last for hours even after stimulation is turned off.

As we begin this study, we’ll be looking for lower limb amputees who have had severe chronic pain in that limb for at least 12 months. Patients must be at least 21 years old and willing to complete several follow up visits for at least one year. Patients who qualify and enroll in the study will have the Altius system implanted. For the first three months after this device is activated, patients will be randomized: half will receive a therapeutic level of stimulation expected to relieve their pain and half will receive a control level of stimulation for comparison. Patients will not know which type of stimulation they are receiving. This period is to evaluate the efficacy of the treatment. However, after the 3-month follow up visit, all patients will receive a therapeutic level of stimulation and may continue using the device after the study.

If you are interested in learning if you are qualified, you can discuss this study with your pain management providers. For additional information about this study you can contact me directly at Teds@arizonapain.com.

Ted Swing has more than ten years of research experience and four years of teaching experience in psychology, has published in top psychology and medical journals, and has presented his research at major conferences. He received his Ph.D. in Social Psychology from Iowa State University and has been the Research Director at Arizona Pain since May 2012.

BACK PAIN

It’s early — too early. Your eyes open up and as you blink away the sleep from your eyes you remember that you should probably replace your bed, or flip it, or whatever the mattress people suggest. Either way, it’s just not comfortable. You roll to your side, and just as you start to pick yourself up you feel this pinch in your back. Wow, is that painful! And also, one of the worst ways that you could start your day.

Back pain affects one in four Americans at some point in their lifetime, which means that chances are, you’ve experienced it. Whether you had a mild muscle strain while working out at the gym or threw it out while helping your cousin move his couch, your back is the center of your body’s universe. If it’s not functioning properly, you’re in for a world of pain, and that’s about as much fun as … well … helping your cousin move his couch.

So what do you do about it? Whether you find yourself immobilized completely or just having a hard time sitting throughout the day, there is help. Today’s pain doctors have so many tools at their disposal that it’s staggering. Take Spinal Cord Stimulation, for example, a newer take on an old classic. It used to be that we used small pads to supply electrical current to the back right above the affected nerve. This would dull the pain, but because the current had to travel through skin and muscle, it took larger amounts of current to get the job done. Although those tools are still effective for many patients, a spinal cord stimulator actually delivers the current right next to the nerve, using much less electricity in the process. It’s an excellent option.

But there’s so much more that we can do to help your problem. Whether it needs surgery, chiropractic care or some other type of treatment, it’s our goal to get you up and at ’em again, using the best possible method possible.

From our families to yours,

Dr. Tory McJunkin and Dr. Paul Lynch Founders of Arizona Pain