Episode 23: Spinal Cord Stimulation for Chronic Pain

You tried injections, physiotherapy and even surgery for your sciatica, but the pain is still there. What else can you try? 

Find out.

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Chapters

• 0:37 What are Spinal Cord Stimulators?
• 2:55 Risks
• 3:25 Applications
• 4:22 Research
• 4:56 Types of Spinal Cord Stimulation
• 5:53 Dr Karmy’s Experience

Transcript

Raveena: 0:00

Welcome to another episode of Chronic Pain Chronicles with Dr. Karmy, where we take a closer look at one of the more advanced and sometimes controversial treatments for chronic pain spinal cord stimulators. I'm Raveena, your host and advocate for making sense of what this evolving treatments mean for people living with chronic pain. As we explore this topic, we're joined by Dr. Karmy, a pain management specialist with over 20 years of experience to break down how spinal cord stimulators work, who they may help, and what you need to know before considering this option.

Dr Karmy: 0:37

Hello, this is Dr. Karmy, and today I wanted to discuss spinal cord stimulators. I already covered a number of approaches to chronic pain, including nerve blocks, cortisone injections, and radio frequency ablation. All of which are covered by OHIP. And now it is time to talk about the last option covered by OHIP, the spinal cord stimulators. It does not exactly correct to say that spinal cord stimulators are covered by OHIP, but rather the cost of inserting spinal cord stimulator is covered by OHIP. However, it is the patient often that has to cover the cost of the equipment. So what is a spinal cord stimulator? Spinal cord stimulator has two components. It has, a. generator, which generates electrical signals, which is typically implanted under the skin as well as leads which are inserted under the x-ray guidance next to the spinal cord. After the spinal cord stimulator is inserted, it is trialed for about a week at different settings to see if it helps the pain or not. And if it is helpful, it is left in place. While if it is not helpful, it is removed. You can remove spinal cord stimulator at a later date as well. However, because sometimes scar tissue forms around the leads, the risk of removal is slightly higher at a later date. If it is helpful and left in place sometimes the effect is reduced over time due to migration of electrodes or scar tissue forming around the electrodes. These procedures are not without risk. In one review, the incidence of complication was about 30 to 40%. In other words, about one in three patients have some sort of complication. Most of them are minor, such as pain at the site of generator insertion. However, 4.6% of the time the procedure can cause infection. The most common indication for the use of spinal cord stimulator is in patients with failed back syndrome, who have radiculopathy. In other words, patients who had disc surgery because the disc was compressing a nerve going down the leg and the surgery did not help. There are a number of other uses for spinal cord stimulation, including treating patients with isolated back pain or patients with phantom limb pain, pain after chest surgery, and even pain in the legs due to narrowing of the blood vessels. However, the strongest evidence is for pain due to radiculopathy or pinched nerve. In general, the quality of evidence for spinal cord stimulator intervention is relatively low. However, that does not mean that it is not helpful as majority of interventions we use for pain management have poor or contradictory research. Typically weak evidence simply means that not enough studies have been done rather that intervention is not effective. Also, I wanted to note that there is many different types of spinal cord stimulation, including devices that provide 10 kilohertz high frequency stimulation devices that stimulate dorsal root ganglion instead of the spinal cord devices that provides threshold less than 1.2 hertz stimulation. And devices that provide differential target multiplexed stimulation. In other words, not all spinal cord stimulators are created equal. And whether or not you respond may depend on what type of stimulator is being used and also what type of protocol. My personal experience with these devices has not been positive. I came across two or three patients who had spinal cord stimulators inserted in Ontario, and generally speaking, either they did not work or they helped initially and then stopped working. Having said all of that, this is clearly a rapidly developing field. I suspect both safety and effectiveness of these procedures is improving over time. It is one of the few OHIP covered treatments for chronic pain, and although the cost of device is not covered by OHIP, perhaps some of the extended insurance plans covered. So to summarize. I do not think of spinal cord stimulator as a first line treatment for patients in chronic pain. However, if they have a pain due to pinched nerve and failed multiple approaches, including nerve blocks, cortisone injections, medications, infusions, and even surgery. It is certainly worth a try. Thank you.

Raveena: 7:15

Thanks for joining us on this episode of Chronic Pain Chronicles with Dr. Karmy. Our episodes focus on common treatments for chronic pain management, like nerve blocks and regenerative therapies to explore what's working, what's emerging, and what to watch out for. We're also excited to bring you episodes featuring guest experts who are actively shaping the future of chronic pain care. From groundbreaking regenerative therapies and stem cell research to ortho biologic therapies that are changing the game. If you haven't already, be sure to follow our Instagram at@karmychronicpain or subscribe to our podcast so you don't miss what's next. Until next time on Chronic Pain Chronicles with Dr. Karmy. Disclaimer, when it comes to your health, always consult with your own physician or healthcare provider for personalized advice and guidance. The information provided in this podcast is for educational and informational purposes only and should not be considered medical advice or a substitute for professional medical care.