Craig Nairn, M.D., Interventional Pain Specialist

Percutaneous Spinal Cord Stimulators (SCS) are a revolutionary treatment that may resolve chronic back pain when all else has failed. 

Advantages of Percutaneous Spinal Cord Stimulators

  • They can provide pain or symptom relief when everything else fails
  • The procedure is reversible
  • No medications are used
  • No systemic side effects
  • The trial is no more invasive than a typical spinal or peripheral injection.

Spinal Cord Stimulators (SCS):  How Do They Work?

A power source (the pulse generator) is attached to electrical lead(s) to stimulate the nerves transmitting the pain signals.  The stimulation effectively changes the pain messages and replaces the pain with a more pleasant paresthesia sensations.  According to the "Gate-Control Theory," activating large, myelinated afferent nerve fibers will inhibit transmission in the small unmyelinated afferent nerves that transmit the pain signal.  Recent stufies have shown an increase in blood flow and natural endorphins as well as positive changes at the cellular level of the nerves and/or spinal cord with neurostimulation. 

The current techniques for SCS and PNS are minimally invasive.  Electrodes can generally be placed during an outpatient procedure with local anesthesia and sedation.  One essential step toward effective use of neurostimulation in potential patients is a trial of the system through percutaneous lead placement.  No incision is necessary and the procedure is performed with only local anesthesia.  The purpose of the trial is to determine the effectiveness of the neurostimulation for relieving the pain and improving the patient's quality of life.  If this temporary placement of the stimulation system provides sufficient analgesia (often measured by >50% pain relief), allows the patient to sleep better, and uses less pain medication, then permanent placement of the system is considered. 

Neurostimulation is generally considered to provide greater than 50% pain relief in over 60% of the patients.  The procedure is more successful when performed by a physician who performs the procedure regularly.  Implementing the modality early in the course of the pain syndrome also increases efficacy.

Spinal Cord Stimulators:  Who Do They Help?

Spinal Cord Stimulators help a broad spectrum of chronic pain syndromes including:

  • Low Back Pain and Sciatica
  • Neck Pain and Cervical Radiculopathy
  • RSD (CRPS)
  • Occipital Neuralgia and Migrain Peripheral Neuropathies
  • Postherpetic Neuralgia
  • Angina
  • Abdominal Pelvic Pain such as Chronic Pancreatitis and Interstitial Cystitis
  • Peripheral Vascular Disease and Raynauds  

Spinal Cord Stimulators:  Potential Risks

  • Bleeding
  • Infection
  • Damage to Nerves
  • Spinal Fluid Leaks
  • Headache
  • Scar Tissue Formation (Fibrosis) around the electrode
  • Pain moving beyond the reach of the stimulator
  • Breakage of the electrode or hardware failure
  • Development of tolerance to the stimulation-- making it less effective