Dr Tascon Fernandez
Consultant in Interventional Chronic Pain Medicine, Acute Pain Management and Anaesthesia, at the Royal National Orthopaedic Hospital
By blocking pain signals to the brain, Spinal Cord Stimulation is redefining living with chronic pain and proving to be a revolutionary alternative.
Take this example:
Colin was involved in a motorcycle accident damaged the nerves in his neck (brachial plexus injury) and lost the use of one of his arms. While managing to find ways to compensate for the disability, over time the man’s nerve-related pain worsened to the point that it had become excruciating. After several unsuccessful procedures, relief finally came in the form of Spinal Cord Stimulation (SCS)… Scroll down to read more about Colin’s journey.
SCS is similar to a pacemaker
“It is a device implanted in the body (epidural space) that generates electrical impulses to block transmission of pain signals to the brain,” says Dr Tacson Fernandez, Consultant in Interventional Chronic Pain Management at the Royal National Orthopaedic Hospital.
For patients with neuropathic (nerve-related) pain, SCS can prove revolutionary.
How Spinal Cord Stimulation works
Implanted via a small incision under the skin, the device is connected to a rechargeable battery that emits an electrical current to the spinal cord, creating a pleasant tingling sensation at the site of the pain.
“Patients are offered a trial where the device is implanted for two weeks,” says Dr Fernandez, explaining that the device is then removed to allow patients time to reflect on the difference that SCS has made to their pain.
“If there is at least a 50 per cent improvement of pain and if the patient is happy with the benefit, we proceed to the full implantation.”
Pain is multi-dimensional, SCS has multiple benefits
A reduction in pain is not the only benefit that patients can look forward to with SCS.
“Pain is multi-dimensional. It affects all aspect of our lives – activities of daily living, mood, appetite, sleep. People become withdrawn and don’t want to go out. Many stop working, so their economic situation changes. Medication can have significant side-effects and there are medical appointments to attend. Life ends up revolving around the pain,” says Dr Fernandez.
Once patients undergo the SCS implant, changes to their quality of life can be dramatic.
“People find they can do more, like walking longer distances. Sleep and mood gradually improve. Often the amount of medication they need is reduced. Even their posture improves,” says Dr Fernandez, describing how one of his patients attended an appointment after the device was implanted and looked much taller as he was no longer stooped over in pain.
Careful considerations for treatment
The decision to fit the device is the result of a careful selection process that involves the patient working with a multi-disciplinary team comprising pain experts, spinal surgeons, radiologists, psychologists.
As with all surgery, there are risk factors that need to be considered. Risks and benefits are discussed in detail during meetings with the patient, including the opportunity to familiarise themselves with the equipment. Not all devices are compatible with MRI scanners – issues the patient has the opportunity to consider with their medical team either prior to or during the ‘cooling off’ period following the trial.
SCS is a cost-effective treatment. While the decision to fit a device isn’t taken lightly, one that has the potential to give patients in chronic pain a whole new lease of life.
Colin’s story: back on the bike with SCS
After dealing with the daily struggle of chronic pain for over 40 years since his accident, Colin ‘cannot believe’ the impact Spinal Cord Stimulaton has had on his pain management, family and life.
On the way to work on January 3rd 1964 at 6.50am, Colin (then 26) was involved in a near-fatal motorcycle accident. The accident lead to a severe brachial plexus injury and to increasingly frequent bouts of chronic pain that would go unsuccessfully treated until 2016.
…like thunderbolts down my arm: completely debilitating.
After the accident, Colin’s right arm was totally paralysed; it was here that the chronic pain developed. “The pain was like thunderbolts down my arm… completely debilitating,” he said.
As the condition developed, Colin did not respond to traditional painkillers, as he found them “totally immobilizing”. After spending entire weekends visiting his family in Germany in bed, “writhing in pain,” something had to change.
SCS and a new-found sense of control
Upon referral to the Royal National Orthopaedic Hospital, Colin received a two-week trial, followed by a spinal cord stimulator implant for brachial plexus injury-induced neuropathic pain.
The whole process of referral, treatment and the results were absolutely “wonderful,” says Colin. “It was life-changing. I don’t regard what I get now as pain, it’s hardly worth talking about.”
Since the operation in January 2016, Colin, now 79, has taken multiple family trips to Germany and done a two-week tour of Spain on his modified motorcycle.
With a new-found sense of control over his condition, Colin is now able to not only manage his pain but also his future.