As the spinal cord is part of the central nervous system, its proper function is critical to an individual’s quality of life. The central nervous system controls the body’s sensory information (pressure, touch, temperature, pain) which travels in established pathways into the spinal cord and onto the brain where the signals are interpreted into the different experiences. When the spinal cord is damaged, it can lead to a variety of symptoms including: loss of movement, difficulty breathing, loss of bowel/bladder control, and many others. Continue reading to learn when a spinal cord stimulator may be necessary to correct a patient’s condition and allow them to live pain-free.
A spinal cord stimulator (SCS) is a small surgically implanted device which transmits electrical pulses that disrupt the transmission of pain signals reducing or eliminating pain from almost any part of the body. It is believed that electric pulses prevent pain signals from being received from the brain. The device itself consists of thin wires (the electrodes) and a small, pacemaker-like battery(the generator). Once implanted, the individual can control the electrical signals from an external wireless programmer to adjust the stimulation, switch between programs, and turn it on/off to alleviate the pain.
Spinal cord stimulators can be an option for patients with a myriad of conditions, including but not limited to:
If you’re a candidate for a spinal cord stimulator, it’s important to understand that there are 2 separate procedures you must undergo; the trial and the implantation.
Both procedures are done under light sedation and patient’s are able to return home the same day.
When it comes to types of spinal cord stimulators, the GSMC team recommends conventional and rechargeable generators to their patients. The main difference being that with a rechargeable stimulator, you can recharge it without another surgery versus a conventional stimulator requiring another surgery. Rechargeable systems tend to last longer, but must be charged 1-2 times a week (noninvasive) while conventional stimulators have no ongoing upkeep, but its battery needs to be replaced sooner.
There are a number of different manufacturers of the device, each having proprietary software to deliver the energy in unique ways. Some stimulators give patients a tingling feeling while others feel nothing other than pain relief. The majority of the systems that our team uses are also MRI compatible as well.
Once the implantation is complete, patients are discharged the same day, typically within an hour after their procedure has finished. In the days following, it is common to feel pain around the incision sites, with the full healing taking between 2-4 weeks. During that time, we recommend taking it easy and avoiding any activities that may aggravate the areas. However, often 1 week after the surgery patients are able to return to work and go about their normal activities.
Peripheral Artery Disease (PAD) is a circulatory problem that occurs when you have reduced blood flow to your limbs. One of the primary symptoms is pain when walking.
According to Mayo Clinic, you can treat PAD by improving your lifestyle, i.e., quitting smoking, exercising, and eating healthy.
When that isn’t enough, a Spinal Cord Stimulator (SCS ) is one alternative PAD treatment that has proven to relieve pain.
What Is Peripheral Arterial Disease?
Peripheral arterial disease (PAD) occurs when the blood vessels outside of your heart begin to narrow. Atherosclerosis causes PAD. Plaque builds up along artery walls.
These arteries supply blood to the arms and legs. The blockage reduces or even stops blood flow, most often to the legs.
If the condition becomes severe, the blocked blood flow causes tissue death. It can lead to the amputation of a leg or foot.
Smoking is the leading risk factor for PAD. Older age in another risk factor. Finally, other conditions that present risk for PAD are diabetes, high cholesterol, high blood pressure, heart disease, and stroke.
PAD increases your risk of stroke, heart attack, and transient ischemic attack.
Many people who have PAD don’t experience any symptoms. Those who may experience numbness, pain, aches, or heaviness in the leg muscles. These happen when you walk to climb stairs.
Another symptom is weak or no pulses in your legs or feet. You may experience sores on your feet or toes. Wounds may take an extra-long time to heal or not at all.
You may have a pale or bluish color to your skin, and a lower temperature in one leg over the other. Your toenails may not grow well, and you may have decreased hair growth on your legs.
How Does a Spinal Cord Stimulator Provide PAD Treatment?
A spinal cord stimulator (SCS) is a medical device that sends a mild electric current to your spinal cord. A surgeon places it under your skin.
The current travels through a small wire from a pulse generator to the nerve fibers of your spinal cord. When you turn the SCS on, it SCS stimulates the nerves in the area where you feel your pain.
This stimulation provides PAD treatment by reducing the pain. The electrical pulses mask and modify the pain signal. It keeps the pain signals from reaching your brain. Sometimes the SCS replaces the pain with a tingling feeling.
The SCS PAD treatment can’t eliminate the source of the pain. Rather, it interferes with the signal traveling to the brain.
The result is pain relief. How much pain relief the person experience varies. Also, some find that tingling feeling to be unpleasant.
For the reasons mentioned above, doctors perform a trial stimulation before they implant the device permanently. The goal for the patient is at least50%pain reduction using the device.
Yet, even a minimal amount of pain reduction can be significant. It could be enough to help you complete daily activities with less pain. It could also reduce the amount of pain medication you have to take.
Stimulation does not work for everyone, however. If it is unsuccessful, the surgeon can remove the trial leads without any lasting harm. Doing so will not damage the spinal cord or nerves.
SCS Components and Variations
Some SCS devices use a low-frequency current, which aims to replace the pain with a mild tingling feeling. This tingling is known as paresthesias.
Other SCS devices use burst or high-frequency pulses to mask the pain without the tingling feeling. Most devices have a paresthesia-free setting.
SCS devices all have three main parts. A pulse generator with a battery creates the electrical pulses. A lead wire with electrodes sends the electrical pulses to the spinal cord.
A hand-held remote control allows you to turn the device on and off. It also allows you to adjust the settings.
If you have a system with a non-rechargeable battery, you will need to have it surgically replaced every few years, depending on how much you use it.
Rechargeable battery systems last up to 10 years or longer, but you have to charge them every day.
Development History and Studies of SCS
Researchers initially developed SCS devices in the 1960s. Since then, doctors have been prescribing SCS for peripheral vascular disease treatment as well as peripheral artery disease treatment.
Cook & Associates Study 1976
In Europe, PAD was the primary indication for SCS. In 1976, Cook & Associates used SCS PAD treatment to heal chronic leg ulcers. In addition to relieving pain, this and other studies have shown that SCS can improve patients with PAD.
Patients who received the SCS devices showed improvements in several areas. They experienced greater exercise tolerance and limb salvage along with a reduction in their pain.
Studies Using SCS to treat Peripheral Vascular Disease (PVD)
In the 1980s through the1990s, researchers in Europe used SCS PAD treatment as an alternative treatment measure for Peripheral Vascular Disease (PVD) as well as for PAD.
PVD causes atherosclerosis of the veins of the lower extremities. It initially presents as pain with walking that is relieved by rest. If untreated, PVD leads to neuropathy and muscle deterioration. It can eventually lead to limb loss.
SCS PAD treatment was and is promising for pain associated with PAD and the related condition of PVD. During peripheral vascular disease treatment, patients experienced less pain.
They also increased circulation, enough to avoid losing a limb. The positive effects last for at least one year in 80% of patients. The effects continue for up to 5 years in 60% of patients.
SCS Improves Multiple Symptoms for Patients with PAD
In 1986, Broseta et al. conducted a study in Spain. It showed how SCS PAD treatment could improve more than pain symptoms in patients with PAD. All patients in this study had pain from PAD in the lower limbs.
During peripheral vascular disease treatment, patients experience relief from their pain as well as better blood flow and an improvement in trophic lesions.
After the trial stimulation, 37 patients received permanently implanted stimulators. After twenty-five month, 29 patients reported 75%-100% pain relief. Fifteen patients showed improvements in blood flow.
The overall conclusion was that SCS is a valid, alternative treatment for moderate PAD, especially when surgery on the arteries is not possible or recommended.
Is SCS PAD Treatment Right for You?
If you have PAD or PVD, then peripheral artery disease treatment or peripheral vascular disease treatment with an SCS device may provide some relief.
While studies show PAD treatment does not help every patient, it has statically provided relief to many.
If you are in the Garden State area, please contact us for an appointment today.