Spinal Cord Stimulation (SCS) has come a long way since it was first used to treat chronic pain disorders 40 years ago. Since then, the safety and effectiveness of the technology has been improved, and it is now used to treat a wider range of conditions. This article will highlight a recent review of the literature by Falowski et al (2008), which tracks the history and evolution of SCS, its current uses and challenges for the future.
As many as one in five Australians suffer from chronic pain, which is why pain reducing technologies are so important. SCS is a procedure which delivers electrical currents to the spinal cord to reduce the intensity of neuropathic pain. This is caused by a functional problem in the nervous system and serves no useful purpose. The pain can vary in severity, and may cause discomfort, distress or even total disability.
Over the past 40 years, SCS has become a widely used procedure, and has the support of many neurosurgeons and anaesthesiologists who specialise in pain management. The popularity of SCS is largely due to its superior success rates. It has been reported that SCS reduces the experience of chronic pain by 50%.
Despite numerous studies, the exact way in which SCS works remains unclear. However, scientists do know that SCS creates electrical fields which may affect many structures in the area where pain is felt. SCS may also reduce pain by promoting the release of pain reducing chemicals.
As SCS has become more developed, it has been used to treat a wider variety of pain disorders. Traditionally, the use of SCS was confined to treating neuropathic pain, including failed back surgery syndrome, complex regional pain syndrome, phantom limb pain and spinal cord injury pain. More recently, SCS has been a successful therapy for angina pain, abdominal or visceral (organ) pain and disorders caused by reduced blood flow to the limbs.
Promising studies show that SCS may offer pain relief for sufferers of angina, a heart condition. SCS may even offer other benefits such as an improved exercise capacity and recovery time. This is likely to be the result of increased blood flow to the heart. In 1973, SCS was shown to also improve blood flow to the lower limbs. This led to the use of SCS to treat chronic critical limb ischaemia, where blood flow to the limbs is significantly reduced.
Originally, scientists believed that abdominal and visceral pain could not be reduced by SCS. Several studies have since shown that SCS can provide relief for people suffering from pain in this area, such as those with cancer in the abdomen or pelvic pain.
There are now many different devices available for SCS. These include trial percutaneous electrodes, permanent plate electrodes, totally implantable rechargeable and non-rechargeable pulse generators (IPG) and RF driven pulse generators. With such a wide range of choice, patients are sure to find a device that suits them best. Patients should be aware that severe complications of SCS such as paralysis are extremely rare. SCS is a very safe procedure, but does pose the small risk of infection or pain at the implant site.
Over a period of 40 years, SCS has become an advanced and sophisticated technology used to reduce patients’ pain symptoms. SCS has been continually improved and is now safer and more reliable. In addition, its potential uses have been extended to include conditions such as abdominal and visceral pain, angina pain and chronic critical limb ischaemia. SCS is now widely accepted as a superior therapy for the management of chronic pain, and continues to gain popularity.
(Source: Falowski S, et al. Spinal cord stimulation: an update. Neurotherapeutics 2008; 5: 86-99)