Treating Pain with Spinal Cord Stimulators

Man with back pain stretching at his desk.

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Spinal cord stimulation is a way to manage various types of pain. A spinal cord stimulator is an implanted device that sends low levels of electricity directly into the spinal cord. Electrical stimulation is a modern way to stimulate the nerves of muscles to treat pain, and it has been used for more than 50 years. Other methods of this type of stimulation are TENS (transcutaneous electrical stimulation) units, peripheral nerve stimulation, dorsal root ganglion stimulation and deep brain stimulation. Many of the latest devices are placed by physicians with highly specialized training in interventional pain management under X-ray and/or ultrasound guidance.

Spinal cord stimulators consist of thin wires (electrodes) placed in the epidural space around the spinal cord. A small battery similar to a pacemaker can then directly send small pulses of electricity to treat pain.

Today’s spinal cord stimulators allow patients to send electrical impulses into the spinal cord themselves using a small device like a remote control. Both the remote control and its antenna are outside the body.

What is spinal cord stimulation used for?

Spinal cord stimulation may be used to treat or manage chronic pain caused by:

  • Back pain, especially back pain that continues even after back surgery (failed back surgery syndrome)
  • Post-surgical pain
  • Arachnoiditis
  • Heart pain (angina) untreatable by other means 
  • Injuries to the spinal cord
  • Nerve-related pain (such as severe diabetic neuropathy and chemotherapy-induced peripheral neuropathy)
  • Peripheral vascular disease
  • Complex regional pain syndrome
  • Pain after an amputation 
  • Visceral abdominal pain and perineal pain

Spinal cord stimulation can improve overall quality of life and sleep, and reduce the need for pain medicines. Stimulation results in new paresthesias, or tingling sensations, in areas of the body that were previously associated with pain. Newer types of devices provide the option for stimulation with and without paresthesias. New waveforms for electricity delivery include high frequency, burst and high-density stimulation. While we are still determining exactly how spinal cord stimulation works, we now know that it may treat multiple regions directly at the spinal cord or even alter the way that the body senses pain at the brain.

Spinal cord stimulation technology

Spinal cord stimulators come in three main types:

  • Conventional implantable pulse generator, or IPG. A battery is placed in the spine during an operation. When it runs out, the battery must be replaced in another surgery. This can be a good choice for people with pain in just one body part because they need less energy to manage their pain.
  • Rechargeable IPG. A battery is placed in the spine during an operation, and can be recharged without another surgery. Because the energy source is rechargeable, these stimulators can put out more electricity. This may be a better choice for people with pain in the lower back or in one or both legs. The device is more powerful than conventional IPGs.
  • Radiofrequency stimulator. This type of stimulator uses a battery that’s outside the body. This stimulator is rarely used today because of newer designs and better technology. It has rechargeable batteries, but like the rechargeable IPGs, it may be better for people with pain in the lower back and legs because of the device’s power.

With all three types of spinal cord stimulators, the level of electricity sent to the spine can sometimes be controlled to make the treatment work better.

Spinal cord stimulation involves minor surgery to put the device in place. The first step is a test or trial period when the patient can evaluate whether the device is able to treat their pain. If unsuccessful, the wires can be easily removed in the clinic without damage to the spinal cord or nerves. If successful and the patient experiences greater than 50% improvement in pain, surgery is scheduled and everything is placed underneath the skin. Spinal cord stimulation is usually used along with other pain management treatments, including medicines, exercise, physical therapy and relaxation methods. Spinal cord stimulation is used most often after conservative pain treatment options have failed to achieve adequate relief.