Spinal cord stimulation (SCS) is increasingly being used for hard-to-treat chronic pain. This treatment typically involves implanting a small device underneath the skin in the lower back or neck. The SCS device then sends mild electrical signals to the spinal cord near the pain source via wires and electrodes. It is believed that spinal cord stimulation can interfere with and reduce the pain signals before they travel up the spinal cord to the brain.

Spinal cord stimulators are small devices implanted under a patient’s skin with the purpose of stopping pain signals from reaching the brain. Watch: Spinal Cord Stimulation for Chronic Back Pain Video

Most SCS devices contain a battery that must eventually be surgically replaced. With rechargeable SCS, the battery can theoretically last several years longer than with traditional SCS.

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Pain Conditions Commonly Managed By SCS

Some pain conditions that are more likely to respond favorably to SCS treatment include:

  • Failed back surgery syndrome. When surgery has failed to relieve back or neck pain, the result is typically called failed back surgery syndrome and may even result in the pain worsening. This condition is the most common reason for SCS treatment to be sought.
  • See Failed Back Surgery Syndrome (FBSS): What It Is and How to Avoid Pain after Surgery

  • Complex regional pain syndrome (CRPS). CPRS typically involves an intense or burning pain that mysteriously spreads to an entire limb, such as the leg or arm. CRPS can occur with nerve damage from an injury, or it may result from a defect in the central nervous system that does not show up on imaging.
  • Arachnoiditis. This condition involves the painful inflammation of the spinal cord’s outer layer.

SCS may also be considered for other causes of chronic pain, such as heart problems and various conditions that cause nerve damage.

See Who May Benefit from Spinal Cord Stimulation

When to Avoid Rechargeable SCS

If a patient anticipates that it would be inconvenient or uncomfortable to regularly recharge the SCS device, which may take many hours per week and increase as time goes on, opting for a standard (non-rechargeable) SCS device instead could make more sense. Although, it should be noted that many rechargeable devices can be charged in less than 1 hour per day, which can be done while watching TV or having a meal.

See Options in Spinal Cord Stimulation

In addition, SCS should be avoided if:

  • The pain is unlikely to be alleviated by stimulation, such as pain from cancer
  • A medical condition would make the procedure unsafe, such as already having a pacemaker
  • Untreated mental health issues are present, such as anxiety or depression

This is not a complete list of reasons to avoid getting SCS. For example, if spine surgery has a good chance of correcting the problem causing pain, it is typically recommended instead of implanting an SCS device.

See Spinal Cord Stimulation Procedure

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Effectiveness of Rechargeable SCS

The exact mechanism by which spinal cord stimulation works to reduce pain is still unknown.1 However, the medical literature increasingly indicates that SCS can be an effective treatment for appropriately-selected candidates dealing with chronic pain in the spine and/or limbs.2 Some research indicates that spinal cord stimulation is more effective at reducing pain felt in a limb, such as the leg, rather than in the spine, such as the lower back2,3, but there can still be meaningful back or neck pain relief.

See Spinal Cord Stimulation for Chronic Back and Neck Pain

It should also be noted that the effectiveness of SCS treatment can greatly depend on the doctor’s skill, product type, and other factors.

While rechargeable SCS in theory should be more cost effective than traditional SCS in the long run due to fewer replacement surgeries needed, this is not always the case. For example, if rechargeable SCS has complications that require a procedure to either remove or replace the device, the potential cost-effectiveness is negated.

Also, if an insurance company is covering the procedure, the upfront costs to the patient tend to be the same regardless of whether a non-rechargeable or rechargeable device is implanted.

References:

  1. Jeon YH. Spinal cord stimulation in pain management: A review. Korean J Pain. 2012; 25(3): 143-50.
  2. Verallis P, Sinclair C, Barnard A. A review of spinal cord stimulation systems for chronic pain. J Pain Res. 2016; 9: 481-92.
  3. Barolat G, Oakley JC, Law JD, North RB, Ketcik B, Sharan A. Epidural spinal cord stimulation with a multiple electrode paddle lead is effective in treating intractable low back pain. Neuromodulation. 2001; 4(2): 59-66.
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