Spinal Cord and Peripheral Stimulation

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Spinal cord stimulation (SCS) and peripheral nerve stimulation (PNS) are treatment options for patients with chronic pain that has not responded to other therapies. In both cases, therapy is historically based on the idea that stimulation interrupts the normal pain sensations, drowning out the pain. More recently, newer technologies use higher frequency stimulation patterns which patients cannot feel, with often even better results. In most cases, the idea of having an implant for pain is daunting, but these threapies offer the opportunity (and often require) a trial to determine whether the treatment works before a permanent implant is recommended.

How Does it Work?

SCS and PNS are considered neuromodulation techniques based on the “gate” theory of pain. Much like you might lightly rub an area that has been hurt to make it feel better, SCS and PNS lightly “rub” an area with electricity to make the targeted region feel better. Newer higher frequency stimulation systems are thought to block the painful sensation completely.

Am I A Good Candidate?

SCS and PNS can be tried on most patients with chronic pain that have not responded to other treatments. The best determinant of benefit is to complete a trial, usually about 7 days, to determine if the therapy is effective. SCS is most often used for patients with leg (or radicular pain) but is now often used for patients with chronic low back pain as well. PNS can be used to target pain anywhere in the periphery, and does not necessarily need to be placed over a nerve. PNS is often considered for chronic headache and facial pain syndromes, although definitive studies to support its efficacy is still pending.

The Procedure

SCS and PNS are done in 2 stages:

1. Stage 1: Trial – a temporary lead is placed in the targeted region with an externalized wire (i.e., wire comes out of the skin) while the patient tries the therapy at home. If after 7 days the patient reports significant improvement in pain (usually considered >50% pain relief), a permanent implant will be recommended.
2. Stage 2: Permanent implant – a new permanent lead (or 2) will be implanted along with a generator to provide a completely internalized system. After implantation, the patients returns for programming of the device to achieve maximal relief.