06 Dec The Role of Spinal Cord Stimulation in Post-Surgical Pain Management
Chronic pain after surgery, such as persistent discomfort following spinal procedures, presents significant challenges for patients seeking recovery and improved function. When pain continues after surgery due to conditions like failed back surgery syndrome (FBSS), various management strategies are available. One of which is spinal cord stimulation (SCS), a technology that specifically targets pain signaling pathways in the nervous system.
What Is Spinal Cord Stimulation?
Spinal cord stimulation uses a device implanted under the skin to deliver mild electrical currents to the spinal cord. The system includes a pulse generator and thin wires positioned in the epidural space near the spinal cord. The electrical pulses stimulate nerve fibers responsible for transmitting pain signals, aiming to change how pain is perceived by the brain.
Many patients experience a tingling sensation instead of pain, while newer devices can provide relief without tingling. The device is adjustable through a handheld programmer and does not remove the source of pain. It modifies how pain signals are communicated, with the intention of improving comfort and reducing reliance on pain medication.
What Can It Address?
Physicians may recommend SCS for neuropathic pain resulting from nerve damage or dysfunction. This may particularly be the case for patients experiencing unresolved pain following back or neck surgery. SCS may be explored when pain radiates to the legs or arms after spinal operations and when re-operation is unlikely to help or may be high-risk. SCS allows for precise targeting of pain areas by adjusting the position of the leads along the spinal column, directing stimulation to specific body regions such as the lower back, legs, or feet.
What Does the Process Involve?
The SCS procedure typically includes two steps: a trial phase and a permanent implantation phase. The trial phase involves temporarily inserting a lead into the epidural space under local anesthesia and sedation. An external pulse generator is worn, and the patient uses the system in their daily environment for several days. If the trial achieves a significant reduction in pain, permanent implantation proceeds.
Permanent implantation takes place in a surgical setting. The physician makes an incision to position permanent leads and creates a pocket for the pulse generator. Leads are connected to the generator under the skin, and functionality is tested before the surgical site is closed. Precautions following the procedure include restrictions on bending, twisting, and overhead reaching to stabilize the leads as healing occurs. Follow-up appointments may be necessary to program and adjust the device to match the patient’s needs and lifestyle.
Confer With a Pain Specialist
For ongoing pain after surgery, SCS offers a pathway for selected individuals who meet certain criteria, including anatomical readiness. Consultation with professionals trained in neuromodulation, including pain management physicians and surgeons, is pivotal for assessment and decision-making. The characteristics of SCS devices continue to advance. Some options include rechargeable and non-rechargeable units with varying longevity. A pain specialist can assist with device selection, discuss procedural details, and outline potential risks, such as infection or lead migration, to support patients in making informed decisions about managing post-surgical pain.
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