Pain Management After Spinal Cord Stimulator Removal
Patients whose stimulators have been removed will need to pursue other therapies to manage their chronic pain. These therapies may include:
- Cognitive behavioral therapy : CBT is a form of psychotherapy that teaches patients ways to cope with a variety of conditions, including chronic pain.
- Medications: Doctors are investigating more effective, less addictive medications for chronic pain. Two types of medications have shown promise:
- Antidepressants: These drugs treat depression by changing how the nerve cells communicate with one another. This same mechanism can alter how the body transmits pain messages.
- Antiepileptics: These medications are primarily used to prevent seizures but can also help calm faulty pain networks that are sending incorrect
Living With A Spinal Cord Stimulator
Many people experience considerably less pain after their procedure than before, which allows them to enjoy a higher quality of life and more mobility.
The implant isnt a cure for the underlying source of pain, and its difficult to obtain long-term pain coverage for longer than
Here are some frequently asked questions people have about spinal cord stimulators.
What Is A Spinal Cord Simulator
As a newer treatment alternative for chronic back and neck pain, a spinal cord stimulator is a small medical device, much like a pacemaker, that utilizes electrical impulses to mask pain signals before they reach the brain.
The device is implanted inside of the body via a needle inserted in the back close to the spinal cord. The pulse generator is then placed under the skin in the upper buttock through a small incision.
Once activated, the stimulator sends electrical signals to the leads to mask pain signals. The patient has the ability to turn the current off and on or adjust the intensity of the signals.
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What Are The Risks
No surgery is without risks. General complications of any surgery include bleeding, infection, blood clots, and reactions to anesthesia. Specific complications related to SCS may include:
- Undesirable changes in stimulation
- Epidural hemorrhage, hematoma, infection, spinal cord compression, and/or paralysis
- Battery failure and/or battery leakage
- Cerebrospinal fluid leak
- Persistent pain at the electrode or stimulator site
- A pocket of clear fluid at the implant site. Seromas usually disappear by themselves but may require a drain.
- Lead migration, which can result in changes in stimulation and reduction in pain relief
- Allergic response to implant materials
- Generator migration and/or local skin erosion
- Paralysis, weakness, clumsiness, numbness, or pain below the level of implantation
Conditions for which you might need additional surgery include movement of the lead, breakage of the lead or extension wire, or mechanical failure of the device. Reasons for removal of the device include infection and failure to relieve pain.
Sometimes scar tissue develops around the electrode and can make the stimulation less effective.
How Is Spinal Cord Stimulation Performed
This is usually done in 2 stages, several days apart. Your admission will be for approximately 7-10 days.Stage 1 You will be taken to the operating theatre, given a general anaesthetic , and your skin cleaned with antiseptic. Local anaesthetic will be injected and you will be lightly sedated. A small incision will be made in your back or neck, and a window of bone shaved off the back of your spine to expose the lining over the spinal cord. An electrode that looks like a miniature paddle will then be carefully placed over the back of your spinal cord. Stimulation will then be undertaken to be sure that the electrode is in a satisfactory position. Temporary extension wires will then be connected to the electrode, and these will be brought out through the skin away from your incision.
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Wound Infection And Wound Breakdown
In a study reviewing 114 cases of infection, Follett et al. reported that 48% of the cases were due to Staphylococcus and 3% were due to Pseudomonas . The remaining cases of infection were unknown/not reported , showed no growth , or were positive for multiple species . Many studies have shown the generator pocket site to be the most common location of infection. Folletts review found 54% of the infections to be in the generator pocket. The SCS leads were infected 17% of the time, the lumbar incision site , multiple sites , and other/not reported . Potential risk factors for infection or poor wound healing included diabetes, debilitated status, malnutrition, extremely thin body habitus, obesity, autoimmune disorder, corticosteroid use, decubitus ulcers, pre-existing infection, poor hygiene, urinary or faecal incontinence, and malabsorption syndrome . summarizes the rate of infection reported in the various studies.
Infection prevention techniques include administration of prophylactic antibiotics, adequate skin preparation, meticulous attention to sterile techniques in the operating room, and adequate wound haemostasis .
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*Paresthesia-free stimulation has been shown to be safe and effective in patients who have been treated successfully with paresthesia-inducing stimulation for at least 6 months.
As measured by the Oswestry Disability Index at 3 months post implant.
Results from clinical studies are not predictive of results in other studies. Results in other studies may vary.
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Get Back To Everyday Activities
Effectively managing your pain can help you get back to enjoying many of the little things in life youve missed. In a clinical study, patients using the Boston Scientific SCS therapy offered in the WaveWriter Alpha SCS System reported a greater improvement in their ability to do everyday activities than patients reported in other studies using non-Boston Scientific SCS systems.4,5,6
The WaveWriter Alpha SCS Systems non-tingling therapy options can be used while driving or sleeping.
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 dont 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:
- Inflammation of the membrane that covers the brain and spinal cord
- Peripheral vascular disease
- 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 didnt relieve your pain
- You are not able to operate your spinal cord stimulator system
- You have a high risk of surgical complications
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What Happens Down The Track
We will keep in close contact with you after your discharge from hospital. You will probably require repeated programming adjustments over the first few months to optimise your pain relief. Your pain medications can be reduced as tolerated.The battery life will vary depending on your stimulation settings . We will need to see you at least once a year to check the battery and ensure you have continued pain relief.
Will Scs Help Your Pain
Doctors use a careful selection process to determine which patients will benefit from the treatment. This process includes the types of pain meeting requirements for the surgery, such as having imaging done and stopping smoking and managing expectations.
Most patients who are referred for SCS have tried other treatments in the pastand thats important. Dr. Leong recommends that SCS candidates have tried the four components of comprehensive pain management before considering spinal cord stimulation: medications, such as such as gabapentin, pregabalin, or duloxetine which are indicated for nerve pain interventional or injection-type pain management therapies, such as trigger point injections, epidurals or medial branch blocks physical therapy and sessions with a pain psychologist.
The last component acknowledges the mind-body connection. Pain wears you down and makes you depressed and it can make your world start to shrink, says Dr. Leong. SCS candidates will attend a few sessions with a pain psychologista requirement of insurance companies as part of the SCS approval process. The pain psychologist is there to coach patients, so they dont think that theres only one magic cure or one therapy for their pain, says Dr. Leong.
Both Drs. Leong and Pilitsis emphasize that SCS will not eliminate all the pain experienced by an individuala 50% improvement in pain, quality of life and function is typically the goal.
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Conditions Treated With Spinal Cord Stimulation
Spinal cord stimulation is recommended for an increasing number of painful conditions. It is most often used after nonsurgical pain treatment options have failed to provide sufficient relief. Spinal cord stimulators are used to treat or manage different types of chronic pain, including:
- Arachnoiditis, a painful inflammation of the arachnoid, a thin membrane that covers the brain and spinal cord.
- Back pain, especially back pain that continues after surgery .
- Chronic neck pain that can include arm pain.
- Complex regional pain syndrome , a chronic, progressive disease characterized by severe pain and swelling.
- Heart pain that is untreatable by other means.
- Injuries to the spinal cord from a fall, motor vehicle accident, sports injury, and similar traumatic injuries.
- Nerve-related pain such as severe diabetic neuropathy and cancer-related neuropathy from radiation, surgery, or chemotherapy.
- Phantom limb pain following an amputation.
- Peripheral neuropathy, a constant burning pain of the legs.
- Peripheral vascular disease caused by an arm or leg injury, infection, or irregular muscle or ligament anatomy.
- Post-surgical pain, chronic pain that lasts more than three months after surgery.
- Refractory angina, which causes chest pain, shortness of breath, and fatigue.
Patients who continue to experience pain after one or more back surgeries that fail to alleviate persistent low back pain, leg pain , or arm pain are also good candidates for a spinal cord stimulator implant.
Who Can Benefit From A Spinal Cord Stimulation
The Lakeland, Florida Pain Doctor recommends spinal cord stimulation when other treatments have not been successful, when surgery is not likely to help, or when surgery has failed. It can also be an option for treating chronic pain associated with sciatica, failed back surgery or nerve pain, or for people who have not benefitted from more conservative therapies.
While the degree of pain relief varies from person to person, many also report a significant increase in their ability to again enjoy normal family and work activities. In addition, reducing pain can have a positive effect on mental outlook and improve the patients overall quality of life.
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Spinal Cord Stimulator Cost 2020
The cost for a spinal cord stimulator procedure depends on a wide array of factors, including the device being used and the insurance carrier. Medicare patients should be aware that spinal cord stimulators have been approved under CPT code 63650. USA Spine Care works with Medicare and most private health insurances, as well as workers compensation and personal injury cases. Our team can answer any questions about cost.
Multiple Therapy Options For Personalized Relief
There are different kinds of SCS therapies.
Some therapies replace your pain with a tingling sensation. Others use a type of stimulation you don’t feel at all.
With the WaveWriter Alpha SCS System, you can choose the therapy that works best for you or use both at the same time. The ability to deliver multiple therapies simultaneously* is unique to Boston Scientific SCS Systems and has been clinically proven to provide greater relief from chronic pain.1
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Are There Any Restrictions After A Spinal Cord Stimulator Implant
After both the trial and permanent surgery, try to limit physical activity. This includes exercise or any work that involves twisting, stretching, or reaching overhead. These actions can cause your stimulator leads to move away from the treatment area. You can resume slow, gentle walks a few days after surgery, but take at least two days off to rest and recover.
As noted, lifting heavy loads can dislodge the spinal cord stimulator implant leads. For at least the first two weeks, do not lift anything heavier than five pounds. Once your incisions are healed, you may begin to gradually increase physical activity. Always talk to your doctor to be sure.
Other important spinal cord stimulator recovery instructions and restrictions include the following:
- Do not drive with the stimulator turned on
- Carry your medical card noting that you have a spinal cord stimulator implant with you at all times
- Carry this card with you while flying, as your device will show up on airport scanners
- Some SCS systems may not be compatible with MRIs
- Follow up with your doctor if the stimulator is not working or you need to reprogram it
Are All Spinal Cord Stimulators The Same
- Thanks to over three decades of clinical experience, more advanced spinal cord stimulator models are now available. A traditional stimulator uses tonic stimulation, where the patient might feel a tingling sensation much like a light massage in the area where they formerly felt pain. Burst stimulation and high-frequency stimulation are newer SCS forms that provide pain relief differently. Your doctor should present the various spinal cord stimulator types and discuss which options are right for you.
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What Is Spinal Cord Stimulator Trial And Implantation
Spinal cord stimulation is a cutting-edge treatment that blocks pain signals from the nerves in the spine to the brain. Patients undergo a trial period first to determine if the minimally invasive treatment is an effective option to improve the patients functionality and decrease the need for pain medication.
The treatment is used for a range of conditions, including chronic neck or back pain, chronic regional pain syndrome, failed back surgery syndrome, arachnoiditis, peripheral neuropathy, radicular pain syndrome and radiculopathies, and reflex sympathetic dystrophy. Technological advances have made the battery-powered generators that are implanted smaller, and some models are now safe to be used with MRI. Controlled sensors automatically adjust to body movement, and generator life is longer.
Your Experienced Spine Care Specialists In Chicago
At The Spine Center, were dedicated to providing you with high-quality, personalized back and neck care. We strive tooffer efficient and professional services to our patients, delivered with integrity and honesty in a state-of-the-art, family-like environment. We have a solid commitment to excellence in diagnosing and treating spinal injuries and conditions spanning all age groups.
As fellowship-trained physicians with over 50 years of experiencetreating spinal conditions, we provide patient advice for treatment, ranging from basic treatment to non-operative therapy and cutting-edge, personalized surgical procedures. Our physicians serve as innovators in technology, actively participate in national and international research studies, and are at the forefront of medical knowledge. If you or a loved one is suffering from back or neck pain, call The Spine Center today at 628-8147 to schedule a consultation.
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Effectiveness Of Rechargeable Scs
The exact mechanism by which spinal cord stimulation works to reduce pain is still unknown.1 However, the medical literature increasingly indicates that SCS can be an effective treatment for appropriately-selected candidates dealing with chronic pain in the spine and/or limbs.2 Some research indicates that spinal cord stimulation is more effective at reducing pain felt in a limb, such as the leg, rather than in the spine, such as the lower back,2,3 but there can still be meaningful back or neck pain relief.
See Spinal Cord Stimulation for Chronic Back and Neck Pain
It should also be noted that the effectiveness of SCS treatment can greatly depend on the doctors skill, product type, and other factors.
While rechargeable SCS in theory should be more cost effective than traditional SCS in the long run due to fewer replacement surgeries needed, this is not always the case. For example, if rechargeable SCS has complications that require a procedure to either remove or replace the device, the potential cost-effectiveness is negated.
Also, if an insurance company is covering the procedure, the upfront costs to the patient tend to be the same regardless of whether a non-rechargeable or rechargeable device is implanted.
Who Is A Candidate
An evaluation of your physical condition, medication regime, and pain history will determine whether your goals of pain management are appropriate for SCS. A neurosurgeon, physiatrist, or pain specialist will review all previous treatments and surgeries. Because chronic pain also has emotional effects, a psychologist will assess your condition to maximize the probability of a successful outcome.
Patients selected for SCS usually have had chronic debilitating pain for more than 3 months in the lower back, leg , or arm. They also typically have had one or more spinal surgeries.
You may be a candidate for SCS if :
- Conservative therapies have failed.
- You would not benefit from additional surgery.
- The pain is caused by a correctable problem and should be fixed.
- You do not want further surgery because of the risks or long recovery. Sometimes SCS may be chosen over a large, complex spine surgery.
- You do not have untreated depression or drug addiction these should be treated prior to having a SCS.
- You have no medical conditions that would keep you from undergoing implantation.
- You have had a successful SCS trial.
SCS works better in the earlier stages of a chronic condition, before a cycle of pain-suffering-disability-pain is established.
An SCS can help lessen chronic pain caused by:
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