Spinal Cord Stimulation
Pain described as burning, electrical, tingling, cold, or crawling without these external stimulus applied to the body are called neuropathic pains. Simply put, it is pain that is caused by the nerve itself or nerve pathology. Neuropathic pain can occur anywhere in the body from the head to the toes. This type of pain responds very well to spinal cord stimulation. Spinal cord stimulation uses electricity to alter the electrical activity of the spinal cord producing an analgesic effect. The electricity is delivered through an implanted electrode (small wire) and pulse generator (programmable battery). This procedure is done in two phases. The first procedure is called the trial phase where the electrode is implanted through the skin and trialed for one week after which it is removed. The second phase is not detailed here.
During phase one, the patient lies face down on the procedure table in a clean operating room. The patient’s vitals signs are collected and checked for appropriateness. The patient’s back, in the appropriate area, is cleaned with an antiseptic and draped using sterile technique. Using fluoroscopic (low dose x-ray) guidance, the area of interest is identified and the skin is anesthetized. Using a needle, the epidural space is entered using fluoroscopic guidance. An electrode is introduced into the epidural space and moved into the appropriate location to produce the desired stimulation of a massaging sensation in the area that was once painful. The electrode, during this phase, will be secured in place for approximately one week while the patient is sent home. The patient will be asked to keep a pain journal to document the use and effectiveness of the trial. The patient’s back may have discomfort where the needle was inserted over the next few days, but this will resolve. The patient wears the electrode and the stimulation is changed during the trial to cover the pain most appropriately. At the end of the trial, the electrode is removed and the patient is questioned to determine the efficacy of the procedure. Based on results, the patient will be recommended for permanent implantation (phase two) or to another treatment modality. The second phase is permanent implantation and is not detailed here.