Spinal Cord Stimulation (SCS) is an option for treating complex low back, neck or related leg or arm pain when other treatments, including surgery, have failed to significantly improve the symptoms, or when the risks of surgery may outweigh the potential benefits. Newer technologies are also expanding the uses of SCS to help with Complex Regional Pain Syndrome (CRPS), and other neuropathic pain conditions.
After being evaluated for an SCS system, a test period of several days with a temporary testing unit will be considered. This is called an SCS trial, and is done as an outpatient procedure. Wires used to create an electrical vibration over the spinal cord are threaded into the spinal canal. There is a soft cushioning space between the nerves and the bones of the spine, and this space is called the epidural space. it’s about 3/8th of an inch wide encircling the nerves, and protects the nerves from impact, such as when we step off a curb or have a car accident, for example. The epidural space has an important job to do. I describe it as if there were “bubble wrap” around the nerves. It is into this soft space that we place the flexible catheter with metal bits at the end called “electrodes”. They are threaded up the middle of the spinal column to where they will be used to create a low-power electrical field, which creates a vibration sensation that travels on nerves that are larger in diameter the pain signals travelling on smaller diameter nerves. When both signals: pain and vibration, arrive at the same time at the spinal column our bodies process the signals and favor the one travelling on the larger nerve. This is how SCS reduces our perception of pain. Once the electrodes are in the correct position, they may be tested for their location or if they are already in a good position tested later. The next step is to remove the needles used to introduce the wires and a stiffening wire used to steer the tip of the catheter is also removed. The flexible catheter electrodes are then secured to the skin and a bandage is applied to hold the wires in place for the remainder of the trial period. It’s important not to remove the tape, because this might dislodge the catheters. Be sure to follow post procedural instructions regarding bandage care. You will not want to get the dressings wet, so bathing will have to be done carefully during the trial period!
Now it is time to turn on the stimulator, to test your response.
Over the first days of the SCS trial there will be an opportunity to get used to the operation of the device that controls the stimulation. There may be some tenderness at the site where the wires were inserted, but this often resolves in the first few days. Sleeping on the tape that keeps the wires in place may take some getting used to, but as the relief from the usual pain improves, sleep may be one of the things that improves for you as well. Getting going in the morning may become less of a chore, and doing things like standing at the counter to get breakfast may become more tolerable. One of the main goals of the SCS trial is to provide information to you as to how much this therapy can help you so, it is important to note the areas that improve. Activities that normally are painful may now become tolerable and enjoyable. At the end of the testing period, the wires are removed along with the tape, and improvement and overall changes are discussed. It is important not only to quantify the amount of pain relief you’ve obtained, but also any improvement in function. This process will help you discern if this is the best therapy for you. If the results of the trial were positive, you may now have the information you need to choose to proceed with a permanent system to be done at a later date, or not. You will discuss the options available during the visit at the end of the SCS trial period with your doctor.