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March 10, 2010 - 4:43pm
SCS for mechanical versus neuropathic pain...
Quick Question:
I've been doing some research on spinal cord stimulators because my PM doc is encouraging me to start thinking in that direction. I've gotten myself confused though because I've read conflicting info about how they work for neuropathic pain versus mechanical pain.
I have mechanical low back pain (although the specific cause is unknown because everything that can be fixed surgically has been done). I know that SCS seem to work well on neuropathic pain, particularly with back pain that travels down to the legs. However, I haven't found much info on how they work for people without nerve injuries. My pain is limited to my low back, and my main pain symptom is that I cannot sit at all. The goal with the SCS would be to improve my sitting tolerance. My concern is that since we don't know what my pain generator is and there isn't a specific nerve root to target with the stimulator, it seems like it may not be super helpful.
Has anyone with mechanical low back pain had success with a SCS?
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I don't have low back pain, but the pain I have in my hips is entirely mechanical. When I went through the trial for my SCS last month, I got 90-100% relief.
None of the problems that I have with my hips are operable, btw.
I'm counting the days until my surgery (I get my Stim on the 23rd!) and I can't wait. It really was amazing not having any pain, after living with it every day for 20+ years.
Chile
Hips - chronic pain starting 1988 @ age 7. Last MRI 2009, 108 injections and 1 nerve burn series, successful SCS trial 2/16/10. Permanent surgery 4/21/10, @ age 28. Neck - 8 unsuccessful injections, next up is a CT - when I get insurance again.
Flexeril, Lithium Carbonate, Trileptal, Ritalin, Seroquel XR
There seems to be no clear cut answer as to exactly who will benefit from an SCS and who won't.
Pain is pain, mechanical pain still travels to your brain. interrupt the pain signal and you have success with the SCS. I don't have an answer where my pain is generated from either, though mine is almost surely nerve damage. My SCS works better at some time then others.
If you have exhausted other avenues of treatment I would certainly recommend you try the trial. That is really the only way to know if it will or will not work for you.
Have you read the stickys at the top of this section?
Gather as much info as you can about the SCS and what it entails, then you can make a more informed decision.
"I have been told my statement or statements are not logical. Would Mr. Spock ride a bicycle down a wooded mountainside when there was a perfectly good stationary bike at home?" NOTICE: Please consult a real DOCTOR before doing anything that may hurt yourself or others! Please be careful!Medtronic SCS Placed May 4, 2009. Cervical, for chronic right shoulder, upper arm pain.
have both radiating nerve pain and some mechanical back pain. I get zero relief for the back pain. I asked my programmer if she could tweak the programs and help me, but she could not. My biggest pain was the nerve pain, so the leads were placed to help that.
For my back pain, the leads would need to be much higher to begin with. And then, the problems could set in. The programmer told me that mechanical back pain is so hard to cover because those nerve fibers run so much deeper and it is harder to get the SCS to reach it. Some people report great relief, but honestly everything I ever read told me it was not great for back pain.
My neurosurgeon, however, uses St. Jude/ANS Eon Mini for nerve pain and the Boston Scientific for back pain and they do their best.
I hope you are able to find relief. My SCS has changed my life.
Take care,
Cheri
Basically you are asking about whether neurostimulation will work for nociceptive pain as well as it does for neuropathic pain. The simple answer is no. The mechanisms are different, the pain receptors are different and they respond to different types of treatment. Neurostimulation is known to be effective for low back pain that is neuropathic in nature, however not low back pain that is nociceptive in nature.
Basically neuropathic pain is pain due to the nerves themselves being injured or "faulty", whereas with nociceptive pain the nerves are working just fine and they are picking up on pain stimuli from the mechanical injury.
Of course bottom line is the only way for you to personally know for certain whether or not neurostimulation will work for you, is to undergo a trial. However, there's always the possibility of the "placebo effect" that can occur during a trial and that generally ends in the permanent system failing to help manage the targeted pain.
For the type of pain you are describing as your chief complaint, it is found that an implantable drug pump is very effective.
"C"
“If it is not right do not do it; if it is not true do not say it.”
Marcus Aurelius
I was going to suggest a pain pump may be your best choice just as "C" said.
Doctors always suggest the SCS first as it is less expensive than a pain pump and more and more Doctors are implanting them. Some PM's are in business just to implant stimulators.
I would research the pain pump just as you have the SCS.
I had the SCS trial, thought it was helping so went ahead and had the permanent implant which did not help me at all. Several months ago I had the SCS removed and am now seeing a new Neurosurgeon about a possiable pain pump implant because my old PM does not do them.
Best of luck to you.
Cheers
Patsy W
I am not a Doctor but I do watch House and Doc Martin on TV.
Never give up HOPE..June 18,2010 I had a pain pump implant....I now free of pain.
My thoughts and opinions are just that, my thoughts and my opinions, based on my experiances.
Thanks so much everyone! You have no idea how helpful your feedback is. I'll definitely be much more prepared with questions for my PM doc. I think I had a false sense of security knowing that the last resort measure of a SCS was available if all else failed, and this helps give me a more realistic picture of what it can and can't do. I am very confident in the PM doc I am working with, but it really helps for me to do my own homework as I make these hard decisions.
Thanks!!