Spinal cord stimulation for low back pain

Treatment Overview

Spinal cord stimulation is a procedure that uses an electrical current to treat chronic pain. To treat chronic low back pain, a small pulse generator, implanted in the back, transmits electrical pulses to the spinal cord. These pulses interfere with the nerve impulses responsible for leg pain due to nerve damage (sciatica).

Implanting the stimulator is considered to be a simple procedure, typically done using a local anesthetic and a sedative. Your doctor usually will first implant a trial stimulator under the skin (percutaneously) to give the treatment a trial run. (A percutaneous stimulator tends to move from its original location, so it is considered temporary.) After a successful trial, your doctor can implant a more permanent stimulator. The stimulator itself is implanted under the skin of the belly (abdomen), and the small coated wires (leads) are inserted under the skin to the point where they are inserted into the spinal canal. This placement in the abdomen is a more stable, effective location. Most stimulator batteries must be replaced every 2 to 5 years.

After this outpatient procedure is complete, you and your doctor determine the best pulse strength. You are then given instructions for using the stimulator at home. A typical schedule for spinal cord stimulation is to use it for 1 or 2 hours, 3 or 4 times a day.

When in use, the spinal cord stimulator creates a tingling feeling, rather than the pain you have felt in the past.

What To Expect After Treatment

You will have a small incision that you should keep clean and dry until it heals.

Why It Is Done

This treatment may be done for people with severe, chronic pain who have:

• Had a failed spinal surgery.
• Severe nerve-related pain or numbness, as caused by sciatica, spinal cord inflammation (arachnoiditis), or scar tissue on the spinal cord (epidural fibrosis).
• Chronic pain syndromes, such as reflex sympathetic dystrophy.

Spinal cord stimulation is typically considered investigational for various other conditions, including multiple sclerosis, paraplegia, and intractable angina.

How Well It Works

Spinal cord stimulation success is generally defined as a 50% or greater reduction in pain. Researchers have reported that more than 60% of people receiving spinal cord stimulation for low back and leg pain (with or without surgery) have pain reduction or relief.¹ Treatment success varies widely, influenced by the cause of pain and, if there has been a previous back surgery, the amount of time that has passed since the first surgery on the affected area. The more time that has passed since a first surgery, the less likely spinal cord stimulation is to overcome the pain signals that have developed over time. One long-term study has shown that:²

• Conditions that are most likely to have long-term benefit from spinal cord stimulation are failed back syndrome (pain that spreads or that continues after surgery), reflex sympathetic dystrophy, multiple sclerosis, peripheral vascular disease, and peripheral neuropathy.
• The sooner after a failed surgery the stimulator is implanted, the better the chances of pain relief.

Initial pain relief is often followed by a gradual decline in effectiveness, apparently caused by the body's increasing tolerance to the treatment.

Risks

Possible risks related to spinal cord stimulation include:

• Scar tissue (fibrosis) developing around the electrode.
• Pain gradually moving beyond the reach of the nerve stimulator.
• Breakage of an electrode or hardware failure.
• Infection.
• Leakage of spinal fluid.
• Headache.
• Bladder problems.
• Getting used to the stimulation, making it less effective.

What To Think About

Spinal cord stimulation is recommended for a small subset of people suffering from chronic pain.

Most spinal cord stimulator batteries must be replaced every 2 to 5 years.

Complete the special treatment information form (PDF) (What is a PDF document?) to help you understand this treatment.

Author:	Shannon Erstad, MBA/MPH Lila Havens	Last Updated: February 15, 2006
Medical Review:	William M. Green, MD - Emergency Medicine Kathleen Romito, MD - Family Medicine Kathie Hummel-Berry, PT, PhD - Physical Therapy Robert B. Keller, MD - Orthopedics
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