How Spinal Cord Stimulation Works

The first step in the process is to get a comprehensive evaluation by a spine physician to determine if the patient may or may not be a good candidate for spinal cord stimulation treatment of chronic pain.

Indications and Contraindications for Neurostimulation

Basic criteria that indicate someone might be a candidate for spinal cord or peripheral nerve field stimulation include:

Although many patients have benefited from spinal cord stimulation and peripheral nerve field stimulation, the treatments are not right for everyone. Importantly, spinal cord stimulation should not be used if a patient has a correctable lesion, which is usually treated surgically.

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Conditions that preclude use of the spinal cord stimulation or peripheral nerve field stimulation include:

  • Individuals with a systemic infection
  • Women who are pregnant or lactating
  • Anyone with a demand type cardiac pacemaker
  • Patients who experience discomfort from the sensation of transcutaneous electrostimulation (TENS) units
  • Individuals who fail to have a greater than 50% reduction in their degree of pain during a trial of stimulation (see discussion below)

Trial Stimulation

Unlike many other forms of pain treatment, spinal cord stimulation always involves a short trial (lasting a week) conducted with a temporary stimulator to determine whether or not spinal cord stimulation will provide the patient with adequate pain relief. The spinal cord stimulator for the trial period is implanted in an outpatient visit, during which:

  • The patient's skin is numbed with a local anesthetic
  • Leads are placed under the skin and attached to a small generator that the patient carries (much like a pager or cell phone)
  • Using pre-set programs, electrical currents are emitted in a pattern to target the areas of pain, with the goal of giving the best pain relief possible.

Placement of the trial stimulator generally takes about 10 to 20 minutes, and the patient can go home soon after the leads have been inserted. Preset programs are used to emit electrical currents in a pattern designed to target the areas of pain.

If the patient enjoys significant relief from pain during the trial, a complete system with a generator can then be implanted.

Spinal Cord Stimulator Surgery

For the permanent system, a surgical procedure is required to place the generator in the upper buttock or abdomen.

  • The patient's skin is numbed with a local anesthetic
  • Leads are placed under the skin
  • A small battery (generator) is surgically placed under the skin in the upper buttock or abdomen.
  • The wires are connected so that the entire system is under the skin.

The entire procedure takes 60 to 90 minutes to complete, and is done on an outpatient basis (meaning that no overnight hospital stay is required). The generator and incisions are so small that patients can wear bathing suits, or participate in any other activities without inconvenience or interruption. Nothing is visible on the body, and there is nothing to carry.

Batteries power the system, and depending on the system and the amount of use the batteries will periodically (e.g. every two to five years) need to be replaced through a follow-up surgical procedure. The recent advance of rechargeable batteries in stimulator generators has reduced the need for frequent battery replacement.