The body’s nervous system can be thought of as a “hub and spoke” model, where the hub (the brain) serves as the central control room that sends and receives messages from the spokes, the nerves in the spinal cord, skin, muscles and other parts of the body.
When there is damage or injury to the nerves (spokes) that transfer information to the brain the result is what physicians refer to neuropathic pain. This pain, which can become chronic, is often described as a burning sensation and hypersensitivity to even the slightest touch or brush of the skin.
What Causes Neuropathic Pain?
Some of the most frequent causes of neuropathic pain are:
- Amputation (also known as phantom limb syndrome)
- Complex regional pain syndrome (CRPS) from indirect damage to the nerves.
- Causalgia, or CRPS-2, from direct damage to the nerves.
- Nerve or spinal cord compression from herniated discs or spinal arthritis
- Spinal surgery
For many years, the treatment options for neuropathic pain were limited to medications, physical therapy, cognitive therapy (biofeedback) or alternative therapies such as massage or acupuncture.
But thanks to advances in research and technology, pain management specialists can now offer their patients with neuropathic pain a new way to address their pain.
Spinal Cord Stimulation for Neuropathic Pain
Research has shown that the body’s nerves are capable of carrying two signals at once. This means that it is possible to intercept a message of pain that is on its way to the brain and replace it with a competing message that is not painful.
Spinal cord stimulators are small devices that are placed just under the skin of the abdomen or buttocks. They contain a small wire that runs between the spine and an external remote. When the patient begins to experience pain, they can activate the remote to send a competing message that is described as a gentle tingling. This sensation is known as paresthesia. Spinal cord stimulation enables the patient to cancel out pain without sacrificing the ability to feel other sensations.
Patients who are candidates for spinal cord stimulation should undergo a trial with the device to ensure it is effective in controlling their pain. Using x-ray (fluoroscopic) guidance, a temporary lead is positioned just as it would be for a permanent implant. It is connected to an external generator and the patient is required to log their pain levels while engaged in a variety of physical activities. Those whose pain is improved by at least half during the trial run are good candidates for a permanent spinal cord stimulator.
Hope for Long-term Relief
Patients who respond well to their temporary spinal cord stimulator can then receive a permanent implant. They can use their spinal cord stimulator’s remote 24/7 to adjust the level of electrical stimulation to meet their specific pain needs. And because the procedure is minimally invasive and is performed on an out-patient basis, patients are able to return to their normal routines within a day or so.
Spinal cord stimulation requires specific training and should be performed by an experienced pain management specialist who can provide the pre-procedure trial as well as the post-implant follow-up necessary for the best outcomes.
Dr. Ioannis Skaribas is fellowship-trained and double board certified in Pain Medicine and Anesthesiology. He has been performing minimally invasive treatments to address chronic pain for more than 25 years and is the only peer-to-peer educator for Spinal Cord Stimulation in Texas, providing instruction to other physicians about the procedure on a monthly basis.