As the expression goes: no pain, no gain. But for those suffering from back pain, there is no gain from this pain!
Indeed, back pain often stops people from enjoying their lives. It’s difficult to focus and concentrate on any activities when you are hurting. If this sounds familiar then a neurostimulator might hold the solution for you.
Back pain is both difficult and expensive. Chronic back pain is one of the main reasons why adults seek medical care.
In the U.S. alone, around 16 million people, or an estimated 8 percent of the population, experience persistent or chronic back pain. Among Americans, a painful back and its complications are one of the leading causes of work-loss days.
Each year, 83 million days of work are lost because of back pain.
In 2008, expenditures in health care in the same study were 2.5 times higher than adults without back pain. Further, people with chronic back pain are likely to report frequent feelings of sadness, anger, or depression than those without back pain.
For these reasons, research and studies on innovative treatments to address chronic back pain are being studied. Technological advances such as spinal cord stimulators (SCS) are most often used after non-surgical pain options have failed.
Neurostimulator implants may be used to manage pain in some of the conditions below.
- Back pain
- Arachnoiditis
- Heart pain
- Pain after amputation
- Complex regional pain syndrome
- Peripheral vascular disease
- Post-surgical pain in a failed back surgery
- Post-amputation pain
- Spinal cord injuries
- Visceral abdominal pain
What is chronic back pain?
Chronic back pain is defined as pain that lasts for 12 weeks or longer. Of those affected by acute back pain, 20 percent of this pain becomes chronic. To determine why people have chronic back pain, doctors assess a person’s ability to walk, sit, or stand. Also, doctors will ask their patients to rate their pain scale from zero to ten and how they cope or function with their pain.
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These assessments are necessary to determine how to manage the pain, rule out other illnesses, and determine the root cause. Some basic diagnostic tests include imaging studies (x-ray, MRI or CT scans, bone scan), blood tests, and nerve studies.
What is a spinal cord stimulator?
A spinal cord stimulator (SCS) is inserted under the skin, which sends a mild electrical current to mask pain.
SCS has thin wires or electrodes placed between the epidural space and the spinal cord. Also, an SCS generator is placed under the skin, powered by a pacemaker-like battery pack or generator.
What are the benefits of a neurostimulator implant?
The main benefit of spinal cord stimulators is to reduce pain. Other benefits of the SCS include improved functioning, less dependence on bracing, less need for pain medications, reduced use of narcotic or opioid, and increased activity and mobility.
Can people have X-rays, CT scans, or MRIs with a spinal cord stimulator?
X-rays and CT scans are generally safe for people when their spinal cord stimulator is turned off. However, people have to check with their doctors if their neurostimulator implants are compatible with certain MRI machines. If not, being assessed under an MRI may cause a serious injury.
Why do I have constant pain in my back?
In some people, pain may be due to one or a combination of factors. Consistent pain felt may be related to work, illness, activities, or psychological conditions. Here are some of the factors why people may have constant back pain.
- The back may be strained from bending too much. Work-related risk factors involve improper lifting in construction, healthcare, or office workers. According to a study, operators, fabricators, laborers, and precision product crafters and repairmen accounted for 54 percent of back injury cases.
- Conditions such as arthritis of the spine, spinal stenosis, or disc problems, may bring chronic back pain.
- Conditions that commonly appear in older people, such as osteoporosis, may result in postural problems. When bones break in osteoporosis, it can cause stooped posture, height loss, and back pain. Also, people are more at risk for falls when they have brittle bones found in osteoporosis.
Activities such as lack of exercise or smoking may contribute to back pain.
Muscles in the back become stiff and weak when people are less active. Pain is due to a more rigid back, and movement may hurt. And when it becomes painful, and the person exercises less, it becomes even more painful.
- Psychological conditions, such as depression or anxiety, may increase the risk of back pain. For people with anxiety disorders—muscle tension, headaches, and body soreness may contribute to back pain.
Who should get neurostimulator implants?
A person is most qualified to get a spinal cord stimulator when doctors have confirmed after imaging tests and psychological screening that SCS is right for them. Other qualifications include those who have not experienced adequate pain management with medications, previous surgeries, or less-invasive therapies. In addition, SCS is recommended for those without psychiatric disorders as some conditions would decrease the neurostimulator device’s effectiveness.
How do I know if my back pain is serious?
People with back pain should seek immediate help if they have any of the symptoms below.
- Fever of 100°F or above
- Unexplained weight loss
- Loss of bladder control
- Pain down the legs and below the knees
- Swelling of the back
- Inability to pass urine
- Constant back pain that does not ease after lying down
- Pain caused by a recent injury
- Conditions such as cancer or infection
Can chronic back pain be cured?
Managing chronic pain is a long process. Those suffering from chronic pain will give almost everything to remove the source of the pain. For this reason, new treatments and medications are being studied, researched, and introduced. These technologies are not for everyone, though. However, some of these interventions, like spinal cord stimulators, work better for some people.
Here are some of the ways chronic back pain may be reduced:
- physical therapy
- meditation
- diet
- posture
- injection-based treatments
- pharmacologic treatments
- alternative treatments
- nerve stimulator
- surgery
Physical therapy
Along with physical therapy, there are several passive or active methods for managing back pain.
On the one hand, through passive methods, a physical therapist can apply heat or ice packs, TENS units, iontophoresis, or ultrasound on the patient to decrease pain.
Passive methods prepare the body for active methods.
Active methods include a combination of therapeutic exercises to improve strength, flexibility, and range of motion to prevent more neck and shoulder pain, including back pain. These methods are often applied for those suffering from disuse atrophy (shrinking muscles from lack of use), nerve irritation, or muscle problems from the inappropriate posture.
An example of exercise involving the active method includes abdominal crunches or leg raises—these core strengthening ones provide a belt of muscle around the spine.
Sometimes, exercises simply don’t work. These are the reasons how exercises may not lessen back pain.
- Patients don’t commit to the prescribed exercise program.
- Patients do the exercises incorrectly.
- The program doesn’t include active methods of physical therapy.
- Patients discontinue an exercise maintenance program at home.
Mindfulness Meditation
This type of meditation practice changes an individual’s present experiences—the ability to pay attention to current thoughts, bodily sensations, or emotions.
When a person has pain, mindfulness meditation trains a person to treat these current things into unique factors. Some of the feelings and thoughts are due to the pain being felt. When people understand their feelings, they can cope better with the pain experience through committed treatments and medications.
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Some tips in mindfulness meditation are listed below.
- Noticing one’s awareness of the body and mind
- Taking a moment to notice inhalation and exhalation
- Focusing on what is happening at the moment
- Delaying reactions to pain for a few moments
Diet
Foods that have an anti-inflammatory effect, such as fruits, lean protein, vegetables, and healthy fats, can reduce pain. Some fruits which can lessen inflammation are strawberries, blueberries, oranges, and cherries. Lean protein, such as fish and chicken, can also lessen swelling. Examples of nuts that can help with pain are almonds and walnuts. Green, leafy vegetables such as broccoli, kale, Brussels sprouts, asparagus, and spinach are linked to the breakdown and healing from inflammatory processes in the body.
Posture
Ways of reducing back pain or other pain in interventional pain treatments are sometimes preventable, especially in improving posture.
Poor posture is one of the causes of chronic back pain. Sometimes, people don’t notice they have bad posture if they’re too focused on what they’re doing or have been used to hunching or slouching over.
Experts recommend stretching and standing up every 30 minutes. Another tip is sitting at the end of the chair and resting the back against it completely.
Injection-based treatments
There are many therapeutic injections, which lessen back pain and address different parts of the body. Examples of these injections involve those being done in the epidural space, joints, and nerve roots.
Pharmacologic treatments
To address chronic back pain, doctors prescribe different medications such as nonopioid medications, narcotics or opioid ones, muscle relaxants, and antidepressants.
Nonopioid medications include nonsteroidal anti-inflammatory drugs (NSAIDS) and acetaminophen. Some examples of NSAIDS are ibuprofen, diclofenac, naproxen, mefenamic acid, or indomethacin. Care should be taken in taking NSAIDS as these drugs can trigger dizziness, gastric irritation, increased blood pressure, and nausea.
Opioids or narcotics are commonly prescribed by doctors to address sharp pain. Because narcotics are more than likely to lead to physical dependence, these medications are prescribed by doctors for less than a week only. Some examples include codeine, fentanyl, hydrocodone, meperidine, tramadol, or morphine.
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Alternative Treatments
Acupuncture, yoga, and massage are examples of alternative treatments that can address chronic back pain.
Nerve Stimulator
One of the most effective non-surgical treatments for pain management of back pain includes spinal cord stimulators. The SCS comes in three main types:
- A conventional implantable pulse generator (IPG) – a non-rechargeable battery-operated IPG which requires another surgery when replaced
- Rechargeable IPG – with rechargeable battery inside the body, which doesn’t require surgery, best for people with lower back or leg pain
- Radiofrequency stimulator – with rechargeable battery outside the body, better for people with lower back and leg pain
Surgery
If most conservative treatments have failed, doctors may recommend surgery. Red flags in chronic back pain indicate the need for surgery when limbs feel weak or if there is evidence of brisk reflexes (quicker than average response).
These kinds of reflexes are dangerous as they are commonly accompanied by dangerous spikes in blood pressure, lightheadedness, flushing of the skin, constriction of peripheral blood vessels, and slow heartbeat.
Other red flags for surgery include problems in bladder or bowel functions and gait and balance.
What kind of pain does a spinal cord neurostimulator help?
A spinal neurostimulator may be used to manage many types of pain, especially chronic back pain. Some of these back pain include surgery from failed back surgery syndrome or post-surgical pain.
Who are the pain management doctors who may perform spinal cord stimulator procedures?
Search online for “pain management near me.” A list of professionals should appear in the search engine results. Also, experts can be contacted here. Below is a list of who can perform spinal neurostimulator device procedures.
What are the risks associated with neurostimulator implants?
As with all procedures, there are risks involved. Risks involve infection following implantation, epidural hematoma or fibrosis, dural puncture, pain, allergic reaction to the device and neurologic injury.
How can I get fitted for a spinal neurostimulator device?
The first step is an SCS trial period. A temporary device will be implanted by the surgeon. Through fluoroscopy, the surgeon will insert the electrodes in the epidural space of the spine through one incision. The generator will be placed outside the body. During the procedure, the surgeon will ask for regular feedback.
In a week, the surgeon will evaluate if the device reduces pain. Pain management should be at least 50 percent for this non-surgical treatment to be implanted permanently. If not successful, the wires will be removed without damaging the spinal cord and its nerves.
What happens during a spinal neurostimulator implantation procedure?
The outpatient procedure may take 1 to 2 hours.
After minor anesthesia, surgeons will make two incisions—(1) to hold the generator and (2) insert permanent electrodes. The generator is then placed underneath the skin. Sterile electrodes, monitored through fluoroscopy, will be anchored by sutures. Throughout the procedure, the doctor will monitor the patient’s condition. The surgeon will close the incisions after the electrodes and generator are connected and running.
How big is the incision made by pain management doctors for spinal neurostimulator?
There are two incisions that the doctor will make. The doctor makes small incisions of 2 to 4 inches long and places the leads.
Are patients put to sleep in a spinal cord stimulator procedure?
Yes, patients are put under general anesthesia. Electrodes are sutured to the spinal ligaments and spinal bone. Incisions will be made in the lower back around the buttocks region.
How do spinal neurostimulator implants work?
Implants of leads or thin wires on the body will deliver tiny pulses of mild electric current through leads to specific nerves. These electric current masks the pain signals to the brain.
Through remote control, stimulation may be switched on and off. A doctor will typically assign two to three settings designed specifically for the patient. Remember, though, that a spinal cord stimulator will only mask the pain—a person still has the same spine.
How do patients recover from a spinal neurostimulator procedure?
Since this is an outpatient procedure, patients typically leave the same day when anesthesia has worn off. Patients are advised not to stretch, reach, or twist as these can be painful when incisions are being pulled. The dressings placed over the incision sites may be removed after three days. Most incisions heal within 2 to 4 weeks after surgery.
Are spinal cord stimulators effective?
Patients have reported in a study that their spinal cord stimulators are effective. In this study, spinal neurostimulator implants are still effective even after a 4-year follow-up.
How long is complete recovery after a spinal cord stimulator surgery?
Expect full recovery from this minimally invasive procedure in six to eight weeks. People can resume light activities in two to three weeks. In the first week, patients should limit walking upstairs or downstairs to one or two times a day. Patients are advised to limit driving or being in the car and restricted to lift anything heavier than two liters in the first two weeks after the operation.
What are some of the dangerous complications in neurostimulators?
Typically, neurostimulator device implantation is safe. However, all procedures contain risk. Some patients may experience infection, bleeding, device damage, movement of electrodes, dural puncture (watch out for cerebrospinal fluid leakage), and spinal cord trauma.
When can I resume sexual activity after an SCS procedure?
People can resume sexual activities or exercise programs when they feel comfortable enough. Remember to avoid strenuous activities or lifting in the first two weeks after the procedure.
Can I swim or drive with a neurostimulation implant?
While driving, the neurostimulator implant should be turned off. This safety procedure is to prevent distractions caused by sudden changes in stimulation.
People can swim if they have an implanted and permanent generator. If what they have is temporary (used in trial mode), they should avoid getting this stimulator wet even in baths and showers.
How long does a neurostimulator implant last?
Spinal cord stimulator batteries typically last for an average of nine years, depending on the usage and equipment used.
Even the lightest of pains are uncomfortable. In most cases of people seeking spinal cord stimulators, their pain has become significant enough to interfere with daily life. Since pain is subjective, combined therapies for controlling pain should be unique. After all, the first step to improving the quality of life is pain management.
What You Can Do Next
If you are curious to know whether a neurostimulator implant is right for you, please give us a call to schedule an appointment to see one of our pain management specialists who can provide a personalized plan of care for you.
Call us at (866) 707-1942 and schedule your appointment today. We look forward to speaking with you.
