Pain, pain, go away: 40 years of neurostimulation

For people living with chronic pain, often from things like failed back operations, there is a treatment option called neurostimulation. This is a technique doctors can use to numb or mask pain. Mostly, doctors will use spinal cord stimulation, or SCS.

Spinal cord stimulation works by putting little electrodes into the spine, close to where your pain is located. The electric current running through the electrodes creates numbness and thus relieves the pain. For people tired of constantly experiencing this sort of pain, the treatment can really improve their quality of life.

Neurostimulation has been in use for 40 years, and is often considered after other treatments have not worked. It is also used in conditions such as complex regional pain syndrome, angina, post-herpetic neuralgia, peripheral neuropathy, peripheral vascular disease and visceral diseases.

Using the device

You must describe your pain in as much detail as you can so that your doctor can treat it in the best possible way. The device parameters are set by your doctor when the electrodes are put in. You can then adjust the device to provide the level of pain relief you need. So the better you understand how it works, the better you can manage your pain.

Researchers are working on technological advances to improve outcomes and cost effectiveness. For those experiencing this type of pain, rest assured that treatments are getting better and better.

Although the immediate cost of the treatment can be expensive, it is the same as or may even be less than the amount of money spent on pain medications over time, especially for people who have recurring pain.

Who should look into this treatment?

Within three years of a failed back operation, SCS devices are a great second-line treatment. Failed back surgery syndrome (FBSS) is actually the most common condition in which neurostimulation is used, so don’t be afraid to ask your doctor about it. Often, getting another back operation does not help and medications are used instead. Neurostimulation is usually considered safe and effective in this circumstance.

It can also be used for a condition called complex regional pain syndrome (CRPS), in which the brain receives abnormal signals and creates the sensation of pain. Often it’s treated with medications or physical therapy, but SCS can help by almost halving pain.

Angina pain can be relieved by these devices for up to 5 years. Neurostimulation is a second-line treatment if conventional treatment strategies such as coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) are not available.

Post-herpetic neuralgia (pain after shingles) and peripheral neuropathies (such as phantom limb pain or diabetic neuropathy) can also be successfully controlled with SCS devices.

SCS has been used to treat some peripheral vascular diseases, most commonly for critical limb ischaemia (CLI), and may be considered for people not eligible for the usual treatments. CLI is a condition in which the blood flow to a limb is obstructed, sometimes so badly that non-healing wounds and gangrene form. SCS works better for people with CLI who have more blood flow to the limb. If gangrene is limited to fingers or toes, then SCS can help reduce how much of the limb needs to be amputated.

Lastly, visceral pain, or pain arising from your organs, is being researched as the latest use for the device. So far, there have been a series of successful applications:

• Pancreatitis;
• Interstitial cystitis;
• Pelvic syndromes;
• Oesophageal pain;
• Mesenteric ischaemia;
• Refractory vulvar pain;
• Abdominal surgery pain;
• Rectal conditions; and
• Irritable bowel syndrome (IBS).

This is still in early stages so further research will be required, but you can talk to your doctor about what your options may be.

In fact, this research has offered new hope for the treatment of pain in a wide range of conditions, improving quality of life for people who are debilitated by pain.

SCS has been working for the past 40 years, and now the next 40 will hold even more effective pain relief for Australians.

For more information, see Spinal Cord Stimulation.

References

1. Mekhail NA, Cheng J, Narouze S, Kapural L, Mekhail MN, Deer T. Clinical applications of neurostimulation: Forty years later. Pain Pract. 2010; 10(2):103-12.
2. Simpson EL, Duenas A, Holmes MW, Papaioannou D, Chilcott J. Spinal cord stimulation for chronic pain of neuropathic or ischaemic origin: Systematic review and economic evaluation. Health Technol Assess. 2009; 13(17):1-154.