Q&A Topic: Spinal Cord Stimulation for Chronic Pain

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Alain C.J. de Lotbinière, MD, CM, FACS, FRCSC

Q. How can spinal cord stimulation help relieve chronic pain?

A. The spinal cord is the highway for nerve impulses that connect your brain to your limbs and organs. Pain pathways travel in specific locations within the spinal cord. Based on knowledge that the spinal cord can, under certain conditions, turn off the pain signals, medical research has developed ways of influencing the transmission of pain impulses passing through it. Since the first crude stimulator implant of the early 1970s, highly sophisticated computerized batteries have been developed that deliver individualized electrical impulses to the spinal cord. Today’s stimulator implant, which is similar to a pacemaker, can eliminate or significantly reduce chronic pain unresponsive to other approaches.

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Q.  Am I a good candidate for spinal cord stimulation?

A. Typical candidates are in chronic pain due to a variety of reasons: There can be structural problems, such as a herniated disc, or patients may have undergone several spine surgeries. Most patients referred for spinal cord stimulation are managed by a chronic pain specialist. Frequently they have tried a host of medicines, including narcotics, but over time, their pain has become increasingly resistant to medications. Many have undergone physical therapy treatments, weight reduction programs and a variety of alternative medicine treatments such as acupuncture. Understandably, these people are desperate. During my consultation, I perform a psychological assessment, as people who are emotionally distraught or depressed because of pain can develop a psychosomatic condition of chronic pain, which responds best to psychiatric care.

Q. What does the implant procedure involve? 

A. Step one is a trial frequently performed by a pain management doctor, which establishes the correct place for the stimulator implant. Guided by X-ray, an electrode is placed in the spinal canal. The patient is brought into a state of light sedation in order to provide feedback as to placement. Once the electrode is in the area of pain, the patient is sent home to monitor its effect. If pain is reduced by 50 percent or more, the person is a candidate for permanent placement of a simulator. I perform this second procedure, which takes about an hour and usually involves an overnight hospital stay. Post-surgery, the stimulator is individually programmed, and over the course of several visits with me, it is increasingly fine-tuned to provide the greatest pain reduction. Special safety measures are taken during the procedure to avoid damage to the spinal cord, while extra steps are taken to reduce the chance of infection from the insertion of a foreign body.

Q. What are the outcomes of this procedure?   

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A. For some, the implant is a godsend, a miracle—eliminating virtually all pain. In others, pain is reduced by 50 percent. Yet others have good initial results, but grow resistant to the stimulator. Then, either it must be reprogrammed for greater precision, or they go on a stimulation “holiday” in which the implant is turned off for a time and then turned back on againin the hope of renewed effectiveness. For a minority, the procedure is a failure. The battery life in today’s implants remains effective for about 10 years.

Dr. de Lotbinière has been treating patients with a multitude of intracranial disorders using stereotactic radiosurgery since 1991. He has performed over 1,000 stereotactic radiosurgical interventions and is recognized worldwide as a leading authority in the field. He was the first director of the Gamma Knife Center at Yale, having introduced the technology there in 1998.

Learn More About Dr. de Lotbinière
Medical Director of the Gamma Knife Center
Medical Director of the Cancer Treatment and Wellness Center
Northern Westchester Hospital

Northern Westchester Hospital is a proud member of Northwell Health.

Read Past Topics from Dr. Lotbinière:
Trigeminal Neuralgia
Treating Metastatic Brain Tumors

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