A solution to unbearable chronic pain: Learn about the Spinal Cord Stimulator

Sometimes we have pain that doesn't go away even with medication or physiotherapy. How difficult is it to live with this kind of pain that drags on day after day, month after month? If you are also someone who suffers from such severe, long-term pain, this article will be very important for you. Today we are talking about a special device that is surgically inserted into the body to control such pain. This can be a good alternative to strong painkillers like opioids, which can be addictive for some people.

Simply put, what is a Spinal Cord Stimulator?

Okay, let's first understand how this works. It requires a little understanding of our nervous system and pain.

What is pain?

Pain is usually a protective mechanism in our body. When you get injured, burned, or are about to be harmed, it's what tells the brain, "There's something wrong here, be careful." Pain is also a key symptom of many diseases.

However, pain does not always provide us with protection. The pain caused by some medical conditions is unbearable. Also, some pain never goes away and continues. We call this chronic pain . When you live with this kind of pain, you can't sleep properly or do any work. When you live like this for a long time, it can be very stressful.

Chronic pain causes changes in our brain and nervous system. As a result, even mild pain can be felt more intensely (hyperalgesia). Sometimes, things that shouldn't hurt can cause pain (allodynia). This means that something is wrong with our pain signaling system.

How does the nervous system work?

Think of your nervous system as a network of telephone lines. Information is carried back and forth between the brain and the rest of the body via these lines. Pain signals are like 'calls' on these lines.

Spinal Cord Stimulation is a method of stimulating certain nerve fibers in the spinal cord using a very fine electrical current . Simply put, before the pain 'call' goes to the brain, this device makes another 'call' on the line. Then, the line becomes busy, preventing the pain signal from reaching the brain. This is how the sensation of pain is controlled.

Who needs this treatment? For what conditions?

This is not a treatment for everyone. It is usually considered an option for severe, chronic pain that has not been successfully treated with other treatments (such as medications, injections, and physical therapy). Although this surgery is most commonly performed in adults, it can also be used for some conditions in young children.

Below are some situations where this treatment may be beneficial.

What happens before this surgery? How do I prepare?

Since this is not a first-line treatment, various tests (such as labs and scans) will be performed before the surgery to make sure you are healthy and to see if there is a reason not to do this surgery.

Also, you will have to see several specialists.

• Neurologist: They are often the ones who can accurately diagnose the condition causing your pain.
• Pain management specialist: This doctor will determine whether other treatments have been successful before resorting to surgery, or whether there is a reason why that treatment cannot be performed.
• Neurosurgeon: They perform the surgery to insert this device.
• Psychiatrist or psychologist: Chronic pain can have a significant impact on your mental health. It is important to check for and treat underlying conditions such as anxiety or depression, as some mental health conditions can make this treatment less effective.
• Anesthesiologist: This surgery is performed under general anesthesia. Therefore, the anesthesiologist will examine you, discuss your health history, and give you the necessary instructions.

After all of this, if it is determined that you are suitable for surgery, you will receive instructions on how to prepare for it.

• Medications you take: You should tell your doctor about all medications you take, including vitamins and supplements. Some medications (such as blood thinners) may need to be stopped or changed before surgery. Do not stop taking any medications without your doctor's advice.
• Cleaning: Instructions on how to shower before surgery and what type of soap to use.
• Fasting: You will be advised to abstain from solid foods for about 8 hours and liquids for about 2 hours before surgery.

What happens during the surgery?

This process usually occurs in two stages. The first is a "trial." If that is successful, the device is permanently installed in the second stage.

This device has two main parts. One is the electrical wires (leads). These are inserted into a space called the epidural space near the spinal cord. These wires are connected to an electrical pulse generator. This is the part that works like a battery and produces the electrical current.

First stage: "Trial procedure"

This involves temporarily inserting a wire to test whether the device is right for you and whether it reduces pain. This is usually done under sedation so that you are slightly drowsy. The doctor uses a special X-ray technique called fluoroscopy (similar to an X-ray video), makes a small incision in the skin, and inserts the temporary wire through a needle into the appropriate location in the spine.

Then, the exposed part of the wires is attached to the skin and connected to a temporary pulse generator outside the body. Now, they turn it on and check to see if it relieves your pain.

If the trial is successful, the next step will be surgery to permanently implant the device.

Second stage: Permanently installing the device (Implantation surgery)

This surgery is performed under general anesthesia. Here, the surgeon, just like in the trial, places permanent electrical leads in the correct location in the spinal cord.

Then, the other end of the wire is taken under the skin and connected to the pulse generator, or battery, which is usually placed in a place that you can easily control. For example, a small 'pocket' is made under the skin on the side of the abdomen or buttocks and sewn inside.

There are several types of these batteries. Some need to be turned on/off with a remote. Some can be recharged. They are recharged on the skin's surface, by placing a special charger where the battery is.

Finally, the incisions are closed with stitches or staples.

What happens after the surgery? How long does it take to recover?

After the trial, you can go home the same day or the next day. After the permanent device is fitted, you will usually have to stay in the hospital for a day or two.

After surgery, especially after the permanent device is inserted, you will be asked to limit physical activity for about 4 to 6 weeks . You should avoid bending, lifting, or doing strenuous exercises until the area where the device was inserted has healed properly and your body has adjusted to it.

You will be asked to come back to the clinic after about two weeks to have the stitches/stapler pins removed.

What are the benefits and risks of this treatment?

As with any medical treatment, there are benefits and risks. It is important to be well informed about both before making a decision.

When do you need to see your doctor?

After the surgery, you will need to go to the clinics on scheduled days. Also, if any problems arise, you should seek medical advice immediately.

How successful is this treatment? Can I live a normal life?

Typically, about half of people who receive this treatment experience more than 50% pain relief . However, this success rate depends on many factors, including the condition of the patient and the type of device used. Your doctor is the best person to tell you how likely it is to be successful based on your condition.

You may need to make some changes to your lifestyle after installing this device. In particular, avoid any bending or twisting as this may damage the device.

However, many people get used to living a normal life with this device. Remember, the main goal is to reduce your pain and improve your quality of life.