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SPINAL
CORD STIMULATION
There have been many
improvements in the treatment of chronic pain. Many patients benefit
from a variety of treatment approaches, but there are those patients for
whom relief is not so easily achievable. Better understanding of the
chemical and physical mechanisms of pain has led to newer, very
sophisticated approaches to the relief of pain.
One new therapy that offers potential for relief of intractable pain is
Spinal Cord Stimulation. Spinal cord stimulation, or SCS, is the
technique of electrical stimulation of a precise portion of the spinal
cord, with very low energy current, which essentially shuts down the
input of pain fibers from a desired portion of the body. The technique
provides pain relief, but dues not interfere with normal sensation,
normal muscular ability, or any other bodily function.
SCS is accomplished using a small wire electrode, or lead, which is
passed through the skin, and comes to rest close to the spinal cord,
along the segment of the cord that is involved with a patient's pain.
One end of the lead rests in what is called the "epidural
space," and, the other end is attached to a battery operated signal
generator, about the size of an oatmeal cookie. After the SCS lead is
placed properly, the signal generator is adjusted to provide a
"pattern" of stimulation that provides maximal pain relief for
the patient.
Not all patients are candidates for this therapeutic approach, but for
those who are, relief can be expected in patients between 70% and 80% of
the time.
Indications for SCS Treatment
1. Failed Back Surgery
Syndrome
2. Adhesive Arachnoiditis
3. Phantom Limb or Stump Pain
4. Peripheral Neuropathy
5. Reflex Sympathetic Dystrophy (RSD), Causalgia, and Complex Regional
Pain Syndrome (CRPS)
6. Ischemic Pain
Patient Selection
Generally, successful
outcome is most likely when Dr. Columbus carefully considers patient
selection. Patients do best if most of the pain is experienced in the
limbs, if the patient demonstrates minimal psychological difficulty, and
if there is no substance abuse.
The Spinal Cord Stimulation Technique
The SCS procedure is
essentially a two-step modality. The first step involves the use of a
temporary lead, which is place through the skin to the targeted level of
the spinal cord. The temporary lead exists the skin and is attached to a
battery-signal generator which is worn on the belt. The temporary, or
trial lead, is kept in place for 3 - 5 days.
If satisfactory pain relief is obtained, the temporary lead is removed,
and at a later date, a permanent lead is placed at the same location.
The remainder of the lead and the signal generator are implanted under
the skin. The signal generator is about the size of a pacemaker battery,
which is quite small.
After placement under the skin, and after the bandage is removed, normal
activities are possible. Little special care is required for the system,
although periodic medical evaluation is a good idea. There are very few
special considerations, and many patients return to a more normal,
satisfying life.
PLEASE NOTE:
There are remarkably
few circumstances where relief of pain is unachievable. The diagnostic
skill of the physician is the most important determinant of successful
treatment of pain. Judgement, which is the ability to properly decide
which of many therapeutic paths to choose, is also important. Without
technical skill, or the physical ability to perform a medical procedure,
the ability to treat a complicated patient fails.
Before considering any intervention, it is extremely important that the
patient makes certain that the physician is properly informed, properly
trained, and uses the highest quality equipment.
Dr. Lynne Carr Columbus has both the diagnostic skill and professional
judgement necessary to successfully perform this medical procedure. She
encourages you to ask questions to confirm that you are properly
informed on this procedure.
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