Pacemaker to control pain?

Back or limb pain is something we’ve all experienced as adults at least once in life, but for some people the pain turns into a long-term condition known as chronic pain. Once diagnosed with it, what are your treatment options? We asked one of Spire London East’s leading pain management specialists – Dr Vivek Mehta, Consultant in Pain Medicine and Neuromodulation, who talked us though a treatment called Spinal Cord Stimulation (SCS).

 What is Spinal Cord Stimulation (SCS)?

Spinal Cord Stimulation is a procedure which alters nerve activity through targeted stimulation to help manage spinal pain effectively, using an implantable pulse generator (IPG), a form of spinal “pace maker”.

What is the real benefit of Spinal Cord Stimulation?

Published studies* have shown that when used by patients with chronic intractable pain, SCS may offer the following benefits:

• Long-term neuropathic pain (often described as shooting or burning pain) relief for chronic pain of the back and or legs, or of the extremities
• Improved quality of life
• Greater effectiveness than repeat surgery, and for those who are unsuitable for spinal surgery
• Successful pain disability reduction
• Better cost-efficiency than conventional medical management and re-operation

How is it done?

It is a day case procedure that involves placing electrodes in an epidural space (outside the spinal column) and IPG “the pacemaker” in the buttock area.  The IPG generates pulses or electrical stimulation that helps to overcome the pain. This is done in a two-stage process to make sure that therapy is effective and the whole process is reversible. We will of course follow you during the trial and post-operative phase to ensure that the device is working.

The therapy is NICE approved and currently 1,500 implants are performed annually in the UK.

Will I be totally pain-free with SCS?

People have different amounts of pain relief with SCS therapy, with many experiencing fewer pain sensations. Your trial procedure will help you find out how much it can help your pain. For some people, SCS works well enough that they don’t need pain medication. For others, it can mean taking less pain medication.

Can I control the stimulation therapy?

Yes, the remote control allows you to turn stimulation on and off, increase and decrease the level of stimulation, and target different areas in your body using settings or programs designed specifically for you. The SCS system is designed for 24-hour-a-day use, should you wish. However, there are times when you should not use it. For example, you should not turn on the stimulation while driving.

How easy is it to recharge the implant battery?

Recharging the implant battery should be simple. The charger is lightweight, cordless and portable so you can charge on the go. You can use either an adhesive patch or soft cloth belt (included with the charger) to hold the charger in place when you recharge.

 Can I get imaging tests with this system?

You can continue to use commonly used methods such as X-Rays, CT scans, PET scans and ultrasounds. In addition, the newer MRI system compatibility devices provide access to full-body MRI scans, under specified conditions, for people who meet the eligibility requirements.

Will I feel the implant?
The implant is small and has a contoured oval shape. This can be positioned in the most comfortable and convenient location in your body. Some people say that they can feel it if they press on their skin. In most cases, it isn’t visible.

What happens when I go through airport security?
Airports differ in their screening processes. When you go through the security, let them know you have an implanted neurostimulator and they will direct you to appropriate place. You will have an ID card to show that you have an implanted device, and you may be escorted around the security machine.

Is spinal cord stimulation safe?
Yes, spinal cord stimulation has been proven safe and effective, and has been in use for decades. More than 400,000 people worldwide** have been successfully treated with SCS therapy.

Dr Vivek Mehta holds clinics at Spire London East Hospital on Monday morning. To book an appointment, please call 020 8709 7817.

The content of this article is provided for general information only, and should not be treated as a substitute for the professional medical advice of your doctor or other health care professional.

References:

* NICE guidance TA 159 published by NICE, 2008
** Boston Scientific