Have you ever wondered why we instinctively rub our elbow after bumping it on a table? Yes, it makes it feel better, but why? There is some science behind this reaction. Simply put, our nervous system sends all sensory signals to our brain. The brain then tells us how to react. But the brain can only handle a limited amount of information at a time. So, when you rub your elbow, your brain “forgets” about the pain temporarily.
What follows is the fancy Doctor explanation of the “pacemaker for back pain” concept. Many pain specialists and spine surgeons are taking advantage of this idea to treat a variety of patients suffering with chronic pain.
Electrotherapy of pain by neurostimulation has been used since two scientists proposed something called the “Gate Control Theory” for pain in 1965. The scientists believed that nerves carrying painful peripheral signals, as well as nerves carrying touch and vibratory sensation, both terminate in the dorsal horn of spinal cord. Each has its own “gate” which opens and closes to allow the signal to be sent on to the brain.
The scientists hypothesized that input to the non-pain-sensing nerves could “close the gate” to the pain-sensing nerves. Under X-ray, small wires can be placed near the spinal cord through a needle. These wires are connected to a surgically implanted generator. The generator is roughly the size of a pacemaker battery. This generator sends an electrical impulse to the wires. It is this electrical impulse that prevents the pain signal from reaching the brain.
At this time neurostimulation for the treatment of pain is used with peripheral nerve stimulation, deep brain stimulation, motor cortex stimulation, and spinal cord stimulation (SCS) described above. SCS is pain relief on demand. It is a useful option when other forms of therapy fail and usually reduces the need for pain medication, while improving activity toleration. It is effective in about 50–70 percent of cases. However, it is an invasive procedure, so it can have complications such as infection, bleeding, and spinal cord membrane puncture. There is also a risk of disconnection or equipment failure. The current battery life for the generator is 5-10 years, and it can be replaced without difficulty.
A trial of stimulation is performed, usually by a pain specialist, which allows the patient to take the device for a “test spin” before deciding to proceed with permanent implantation. SCS is a recognized treatment option covered by most insurance policies, including Medicare.