Spinal cord stimulation (SCS) for chronic pain

Overview

Spinal cord stimulation, or SCS, is a treatment for certain kinds of long-lasting pain. Thin wires, called leads, are placed in the space over the spinal cord. They send mild electrical signals that may change how pain messages reach the brain. One of the most important parts of SCS is the trial. You test the system for several days before anything is permanent. If the trial helps enough, a permanent system may be placed. SCS does not cure the cause of pain, and it is not right for everyone.

Watch: how Spinal Cord Stimulation works

Video: “How SCS Works” from MedtronicChronicPain on YouTube. It loads from youtube-nocookie.com only when you press play. Shown for general education; GSMC did not produce it. Watch on YouTube

Video: “Pain Management at Garden State Medical Center: Spinal Cord Stimulator Patient Story” on YouTube, posted by Dharam Mann, MD (gsmedicalcenter). A GSMC patient describes her own experience with a spinal cord stimulator. Individual results vary. It loads from youtube-nocookie.com only when you press play. Watch on YouTube

What it is

SCS is a type of neuromodulation, which means it changes how nerves send signals. A small battery, called a generator, powers the leads. Depending on the system and settings, some people feel a gentle tingling, and others feel little or nothing. Different types of signals are available, such as high-frequency and burst stimulation. Your physician will explain which options may fit you.

Who it's for

SCS may help some people with:

• Failed back surgery syndrome (also called persistent spinal pain syndrome): ongoing back or leg pain after spine surgery
• Complex regional pain syndrome (CRPS): burning pain, swelling and skin changes in an arm or leg, often after an injury
• Refractory radiculopathy: ongoing nerve pain down an arm or leg that has not improved with other treatments
• Painful diabetic neuropathy and some other nerve pain

SCS is usually considered after other treatments have not given enough relief.

What the procedure involves, step by step

Step 1: Evaluation. We review your history, exam and imaging. Many insurance plans also ask for a psychological evaluation before a trial. This is a standard step and helps make sure SCS fits your goals.

Step 2: The trial. 1. In an outpatient procedure, the skin is numbed and thin temporary leads are placed through a needle into the epidural space, using live X-ray guidance. 2. The leads connect to a small device you wear outside your body. 3. For about 5 to 10 days, you go about your normal routine and track your pain, sleep and activity. 4. The temporary leads are removed in the office. This usually takes a few minutes.

Step 3: The decision. You and your physician review how much your pain and daily function changed. If the trial did not help enough, nothing more is placed.

Step 4: The permanent implant. 1. If the trial helped, a permanent system is placed in a separate outpatient procedure with sedation or anesthesia. 2. Leads are placed in the epidural space and connected to a small generator under the skin, often in the buttock or lower back area. 3. The incisions are closed, and most people go home the same day. 4. Your care team programs the system and shows you how to use the remote.

Recovery and what to expect

• After the trial: avoid bending, twisting and lifting so the leads do not move. Keep the dressing dry.
• After the permanent implant: soreness at the incisions is common for a week or two. You will usually avoid bending, twisting, reaching overhead and heavy lifting for several weeks while the leads settle.
• Follow-up visits are used to adjust the settings.
• Some systems need recharging; others do not. The battery may need to be replaced after several years, depending on the system.

Candidacy: who may or may not be a good fit

May be a good fit: people with chronic pain of the types listed above who have tried other treatments without enough relief, who have realistic goals and who have a good response during the trial.

May not be a good fit: people with an active infection, a bleeding problem or blood thinners that cannot be safely paused, untreated depression or other mental health conditions that need care first, a condition that needs surgery to fix, or who are unable to use the device. Some people do not get enough relief during the trial.

Risks in brief

Risks include infection, bleeding, a lead moving out of place, pain at the generator site, device problems and the need for another procedure. A spinal fluid leak and headache are uncommon. Nerve injury is rare. Many current systems allow MRI scans under specific conditions; ask about your system before any MRI.

Alternatives

Other options may include physical therapy, medicines, injections, radiofrequency ablation, dorsal root ganglion stimulation, peripheral nerve stimulation, an implanted pain pump or, for some people, more surgery. You can also ask for a second opinion.

Frequently asked questions

Coverage for Spinal Cord Stimulation

Spinal cord stimulation (SCS) usually happens in stages: an evaluation, a trial period and, if appropriate, a longer-term implant. Insurance plans often review each stage separately, so it helps to understand your benefits early.

Coverage varies by plan. Prior authorization is commonly required, and some plans have other requirements before they approve a trial or implant. Our team will help you understand the steps your plan asks for and support you through the authorization process.

Garden State Medical Center participates with all Aetna plans, including Aetna HMO. Aetna HMO plans may require a referral from your primary care physician. Other neuromodulation options, such as dorsal root ganglion (DRG) stimulation and peripheral nerve stimulation (PNS), may also need a benefits check and prior authorization. We're happy to help you look into coverage for those as well.

If you'd like to learn whether spinal cord stimulation or a related option may fit your care plan, call 732-202-3000 to check your benefits or schedule a consultation with Dr. Dharam Mann.

Insurance

Garden State Medical Center participates with all Aetna plans, including Aetna HMO, and works with many other insurance carriers. Coverage for any procedure depends on your plan, and prior authorization may be required. Our staff is happy to help verify your benefits and explain what to expect before treatment. Please call 732-202-3000 with your insurance card handy, and we'll help you take the next step.

See accepted insurance

Related pages

Related conditions

• Failed back and neck surgery
• Post-laminectomy syndrome
• Neuropathic (nerve) pain
• Low Back Pain
• Spinal Stenosis

Related treatments and resources

• High-frequency neurostimulation
• DRG stimulation
• Closed-loop SCS (Evoke)