Like any chronic pain treatment, there are both appreciable advantages and risks/disadvantages involved with spinal cord stimulation. In general, the biggest risk of this treatment is that it does not work for everyone—most studies show that about 50-60% of patients who try neurostimulation find meaningful pain relief (e.g. reduction of pain of at least 50%).
Advantages to Stimulation Treatment
There are many advantages to spinal cord or peripheral nerve field stimulation for the treatment of chronic back pain:
- A trial can test patient response before the patient commits to a permanent implant.
- It has few side effects and is easily reversible; if it doesn’t work or is no longer needed it can be removed.
- Implantation of the system is minimally invasive, requiring a relatively minor surgical procedure on an outpatient basis.
- Leads are inserted just under the skin, and patients can travel anywhere, and participate in any recreational activities, including swimming.
- Achieving pain relief with spinal cord stimulation or peripheral nerve field stimulation can allow patients to reduce or eliminate their use of narcotic drugs.
- Ongoing advances in neurostimulator technology give patients more control to adjust the stimulation if their pain changes in location or severity.
- Continual improvements in the design of electrodes and longer lasting, rechargeable batteries mean that implantable systems can be placed in locations to give optimal and more efficient pain control than other modalities.
Disadvantages of Spinal Cord Stimulation
As with any chronic pain treatment, there are also a number of potential disadvantages with spinal cord stimulation, including:
- Spinal cord stimulation does not work for everyone. Most studies show that 50% to 60% of people find meaningful pain relief with spinal cord stimulation.
- It does not eliminate the pain. A successful outcome of spinal cord stimulation is considered to be pain relief of 50% or more.
- Spinal cord stimulation does not address the source of the pain. The system is designed to interrupt pain signals being sent to the brain, but it does not correct any underlying anatomical problem. For many people with chronic pain, this is the right approach to treatment. However, for those with a correctable anatomic lesion, treatments to address the source of the pain should be tried first.
- The treatment involves an implant and surgery. As with any surgical procedure and implant, there are certain risks and potential complications associated with spinal cord stimulation and peripheral nerve field stimulation, discussed below.
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Risks and Potential Complications of Spinal Cord Stimulation
As with all surgical procedures, there are potential risks to stimulation therapy, although most are relatively minor. Risks include:
- Allergic reaction to the implanted materials
- Pain at the incision site (usually resolves in a few weeks)
- Weakness, numbness, clumsiness, paralysis
- Battery failure and/or battery leakage requiring a surgical incision to remove and replace the battery
- Fluid leak from the spinal cord, causing headache
- Undesirable changes in stimulation may occur over time due to scar tissue forming around the leads, or movement of the lead position
- Undesirable or unpleasant stimulation of the chest or rib area as a result of nerve root involvement
- Migration of the electrode may occur, resulting in a loss or change of stimulation
- Skin breakdown over the generator or electrode site
- Stimulation may work for a period of time and then lose effectiveness after 1-2 years
Additional Information about Spinal Cord Stimulation and Neurostimulators
Spinal cord stimulation and peripheral nerve field stimulation expand the range of treatment options for patients experiencing chronic pain. Patients with chronic pain should consult with their physicians to discuss whether stimulation therapy could be right for them given their medical history.
- Cameron T. Safety and Efficacy of Spinal Cord Stimulation for the Treatment of Chronic Pain: a 20-year Literature Review. J. Neurosurgy: Spine. March 2004, 254-267.
- Taylor RS, Taylor RJ, Van Buyten, Buchser E, North R, Baylis S. The Cost Effectiveness of Spinal Cord Stimulation in the Treatment of Pain: a Systematic Review of the Literature. J Pain Symptom Manage. April 2004:370-378
- Kemler MA, Barendse GA, van Kleef M, de Vet HC, et al. Spinal Cord Stimulation in Patients with Reflex Sympathetic Dystrophy. NEJM. 2000;343:618-24.