Research Shows Spinal Cord Stimulation for Chronic Pain Yields Better Results if Trialed Sooner Rather than Later
By Erik Shaw, D.O.
Interventional Pain Management Specialist, Shepherd Pain Institute
Chronic pain is pervasive in our country, with 30 percent of Americans experiencing it. Causes include cancer, spinal cord injury, multiple sclerosis, diabetes and degenerative disease (back and neck pain, knees, hips, etc.). Treatments for these conditions range from conservative to aggressive.
As a physical medicine specialist, I focus on both preventive and management strategies for pain control. These strategies include exercise, strength training, use of appropriate equipment and correct diagnosis for proper treatment. One such treatment – considered by some to be on the more aggressive end of the spectrum – is spinal cord stimulation (SCS).
SCS is a well-established technology that has been in clinical use for about four decades. It involves placing an electrode array in the epidural space floating behind the spinal cord. To determine whether this device will help alleviate a patient’s pain, we perform a trial. We implant temporary leads into the epidural space and connect them to a temporary pulse generator worn on the outside of the body. This trial generally lasts three to seven days and is sufficient to determine if the device will help the patient.
An implantable pulse generator, similar in size and shape to a pacemaker, sends an electrical impulse to the electrodes, and a sophisticated computer controls the signal. This computer can be easily programmed and the stimulation adjusted to ensure good coverage of the areas where the patient is experiencing pain. This device is used to treat pain after back surgery, complex regional pain syndrome, neuropathies and other types of chronic pain.
Krishna Kumar, M.D., a well-respected neurosurgeon, recently presented a poster at the annual meeting of the American Academy of Pain Medicine, in Phoenix, Arizona. He has published many articles regarding SCS, and this recent poster showed much higher success rates when SCS was trialed within two to five years after the onset of chronic pain. The poster did not address the reasons behind this finding, but I have some possible ideas.
Pain can lead to decreased activity and decreased endurance. The longer this process spirals downward, the more difficult it can be to reverse it. Also, chronic pain can cause a significant psychological toll on a patient and their family, and pain can take over a person’s whole life. The longer the patient is suffering in pain, the more likely they are to become entrenched in their illness. I understand this may be a foreign concept, but it is well documented in published pain research.
While the SCS implanted technology may seem extreme, it is can be beneficial for some types of chronic pain and should be considered early in pain treatment rather than exhausting time and and all medications and other conceivable treatments.
ERIK SHAW, D.O., is an interventional pain management specialist at the Shepherd Pain Institute. Dr. Shaw is board certified in physical medicine and rehabilitation, as well as pain medicine. For more about Dr. Shaw, click here. For more about Shepherd Pain Institute, visit www.shepherdpaininstitute.org.
Shepherd Center, located in Atlanta, Georgia, is a private, not-for-profit hospital specializing in medical treatment, research and rehabilitation for people with spinal cord injury, brain injury, multiple sclerosis, spine and chronic pain, and other neuromuscular conditions. Founded in 1975, Shepherd Center is ranked by U.S. News & World Report among the top 10 rehabilitation hospitals in the nation. In its more than four decades, Shepherd Center has grown from a six-bed rehabilitation unit to a world-renowned, 152-bed hospital that treats more than 900 inpatients, 575 day program patients and more than 7,100 outpatients each year.