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Managing Pain 2020

Spinal cord stimulation for patients with chronic arm, leg or spine pain

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Mr Adam Williams

Consultant Neurosurgeon, North Bristol NHS Trust

Spinal cord stimulation is an increasingly helpful technique in the treatment of carefully selected patients with low back and leg or arm pain that has persisted beyond standard surgical treatments.

We know that chronic pain has a profound impact on patients; beyond the physical pain involving complex changes in the brain and the disability, it also affects their occupation, their mood, their sleep and their relationships. This means that treatments for chronic pain are challenging and require approaches to address both the physical and psychological aspects.

What is it used for?

Spinal cord stimulation (SCS) is an advanced treatment for chronic pain that we have found is helpful for certain patients with a type of pain called ‘neuropathic pain.’ This is normally pain in the arm or leg that has not responded to standard surgery on the spine. However, SCS is occasionally used for rarer pain conditions such as complex regional pain syndrome (CRPS) or nerve pain from long-term diabetes.

How does it work?

It works by placing a device similar to a heart pacemaker under the skin with minimally invasive surgery and passing electrodes from this device through the spine and resting them on the surface of the spinal cord. The stimulator then transmits a variety of electrical waves that can help mask the excess pain signals the body is producing. With some newer waveforms, SCS may also reduce the negative emotional response to the pain in the brain itself.

Who is it helpful for?

Diagnosing which patients are likely to benefit from SCS is a highly specialised process and requires a team of clinicians including pain doctors, neurosurgeons, neuropsychologists and specialist nurses. Even then, the patient requires a trial of the stimulation to assess whether it is helpful to them before the final device is surgically implanted.

What might the future hold?

This is a rapidly expanding field of medicine and there are a number of exciting developments that might provide further benefits to patients. These include more advanced ‘multi-waveform’ technology, devices with batteries that do not need to be implanted and others that can ‘read’ signals in spinal cord and adapt the stimulation to them. We hope this will enable us to improve outcomes and indeed to treat patients with other causes for their pain.

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