A spinal cord stimulator trial (SCS trial) is a temporary medical device placed under your skin that sends a mild electric current to your spinal cord to block the feeling of pain. The goal of the stimulator is to help you to better manage your pain and potentially decrease the amount of pain medication you needed. The trial period is a patient’s “test drive” to determine if it is something that will help them long-term.
There are many ways the stimulator can be programmed. When turned on, the stimulation can feel like a mild tingling in the area where pain is felt or it can be set not produce any tingling sensation at all.
Stimulation does not eliminate the source of pain; it simply interferes with the signal to the brain. A trial is typically 5-8 days long. The goal for spinal cord stimulation is a 50-100% reduction in pain. At the end of the trial the stimulator is removed. We then discuss with our patients if it is something, they want implanted long-term. Stimulation does not work for everyone, and if so, the implant can be removed and does not damage the spinal cord or nerves.
What conditions are treated with spinal cord stimulation?
There are many neuropathic pain or nerve pain conditions treated with spinal cord stimulation. Spinal cord stimulation is commonly used to treat the following conditions: failed back surgery syndrome, post-laminectomy syndrome, complex regional pain syndrome (CRPS), neuropathy, refractory lumbar radiculopathy, chronic abdominal pain, and refractory angina pectoris. Most patients with these conditions experience 50-100% relief.
Overview of the Spinal Cord Stimulator Trial and Permanent Implant Process:
Stage 1a: Pain Physician visit (evaluate your pain condition to determine whether your pain syndrome is helped by spinal cord stimulation).
Stage 1b: Diagnostic imaging and lab ordering (an MRI may be ordered to determine whether you have enough spinal space to have a lead safely placed).
Stage 2: Psychological evaluation (to understand your needs and expectations of therapy, also a requirement of insurance companies).
Stage 3: Trial stimulation (to evaluate the effectiveness of pain reduction, 5-8 days).
Stage 4: Permanent implantation (this may be performed by your pain physician or occasionally a spine surgeon depending on your pain syndrome needs).
The surgical procedure will entail placement of the lead in the epidural space of the spinal cord and placement of the battery in the buttock or flank.
How is the procedure performed?
Our team will help position you to make sure the procedure can be completed with the least amount of discomfort for you. An IV is placed and antibiotics are given. The skin is cleansed with a sterilizing solution (chlorhexidine) and a sterile drape is placed. A local anesthetic medication typically (Lidocaine) is given to numb the skin. Next, fluoroscopy (x-ray) or ultrasound is used to find the target.
The physician will provide local anesthesia (numbing medicine) and place the needle into your epidural space. They will then place the spinal cord stimulator lead into position. This will all be done under x-ray. Once it is in the right place, the representative from the company will help program it to make sure it is in the best possible location for each patient. Once this is accomplished, the needle is removed and the lead is left in place and taped to your skin with sterile tape. You then can go home and use the device. During the entire procedure you will be constantly monitored by our team. You will be given time after the procedure to make sure you feel good and are not having side-effects before leaving the clinic.
Does the procedure hurt?
The procedure is typically well tolerated. A localized burning sensation from the anesthetic is commonly felt and is usually the most uncomfortable part of the process. During the procedure a pressure sensation is often experienced this typically resolves within a few minutes. Minor soreness for a week after the procedure is normal.
How long does the procedure take?
The procedure typically takes about 45 minutes to perform. Please plan on being at the clinic for about 1-2 hours to allow for pre and post-procedural safety protocols.
How quickly will I get relief?
The stimulation takes some time to reach peak effect patients typically being getting relief 24 hours after the procedure.
Can I have the injection if I have diabetes?
Yes. It is important to control your blood sugar before and after the injection. Diabetic patients may experience a temporary increase in blood sugar which should be monitored closely for days following the procedure.
What are the risks and side effects?
Risks and side effects are minimal and serious complications are rare. We take every precaution to ensure safety. Potential risks may include but are not limited to: vasovagal response (passing out), new or increased pain, infection, bleeding, permanent skin changes, allergic or unexpected drug reaction with minor or major consequences, and unintended nerve injury.
Please let us know if you have an active infection, are using antibiotics, or are using blood thinners.
Should I take my normal medications as scheduled?
Yes. Continue taking your prescribed medications prior to procedure.
What If I am on a blood thinner or Aspirin?
Anticoagulation is often stopped for a short period of time prior to injection. Please speak with your primary physician if you take blood thinners to make sure that you can safely stop taking these medications.
Do I need a driver?
Yes. For your safety we require a driver to ensure a safe return home.
Can I eat the day of the procedure?
It depends on the location. We recommend eating a light meal if the injection is done in our clinic. If the procedure is done at the surgery center then you must fast for at least 8 hours prior to the procedure.
Can I get sedation or anesthesia?
Most patients do well without sedation. Light sedation with oral medications is sometimes provided at the provider’s discretion.
What if I am pregnant?
There are serious potential risks to an unborn fetus when exposed to imaging studies, including x-ray and fluoroscopy. If there is any chance you may be pregnant, please postpone this procedure until it can be confirmed that you are not pregnant as it is not safe to do during pregnancy.
What should I wear?
We recommend light loose-fitting clothes. Sometimes we will ask you to change into a gown.
When can I drive after the procedure?
We recommend resuming driving the next day.
What can I do if I am sore or have pain after the procedure?
Ice packs can be applied to the area for 20 minutes per hour. Over the counter Tylenol and Motrin can be used to aid with any discomfort.
What are my restrictions after the procedure?
Typically, you may resume light activities on the same day following your procedure. During the trial period we recommend limiting any bending, lifting, or twisting. We recommend not lifting anything greater than 5 LBS.
When can I shower?
You cannot shower during the trial period. Sponge baths are okay. Showering can be restarted when the leads are removed. We do not recommend submerging the wounds in water until the small wounds have completely healed; this typically takes about 1-2 weeks.
When do I come back for a follow-up visit?
We follow-up with all of our patients after their procedures. We typically see our stimulator trial patients back in about 1 week.