Advanced Pain Therapies
Implantable Spinal Chord Stimulators
In this procedure, one or two wires are placed into the epidural space to provide electrical stimulation of the spinal cord, acting to interfere with the transmission of pain. This technique is very effective in arm and leg pain caused by nerve injuries and can also be useful in some low back pain not relieved by surgery. It has also been used to treat pain from vascular insufficiency and chest pain. The stimulation can be turned on and off or adjusted by the patient, thereby adding an element of personal control to the treatment of pain.

The wires and the electrical generator are surgically placed. Prior to such permanent placement, a trial is performed. In this trial, the wires are placed through the skin without an incision and attached to an external power supply worn on the patient's belt. The patient may then go home and use the devise for several days to determine its effectiveness in treating pain. Only if the patient's painful area receives stimulation and if this stimulation reduces pain and improves the patient's function is a permanent implant considered.

The permanent implant may consist of small wires or large flat paddles. The flat paddles require a more extensive surgical procedure called a laminectomy but provides more efficient energy output, less chance of movement and more extensive coverage. The decision regarding the type of implant to be used is made on an individual basis, based on the pattern of the patient's pain, the results of the trial stimulation, and the patient's preference.