A small percentage of patients suffer chronic pain which fails to respond to simpler interventions and this group requires advanced pain therapy which requires implantation of device to provide ongoing and effective pain relief. It is also called as Neuromodulation which brings about modulation of perception of pain and significantly improves quality of life. There are basic two categories namely Electrical [Spinal cord stimulation] and Chemical [Intrathecal pump] neuromodulation.
Spinal cord stimulation is the most common mode of electrical neuromodulation used in managing chronic intractable low back and leg pain. It is also used to control intractable neck and arm pain. This modality has been increasingly used over the past two decades with more refined and improved hardware technology. It is minimally invasive and reversible as opposed to nerve ablation. The implantation is preceded by a trial during which the patient can experience the degree of relief the system is likely to offer. Once fully convinced the second stage of permanent implantation is performed.
Our center has the largest experience in offering this therapy with comprehensive approach and we have done this for various indications over the past 12 years. There is stringent selection criteria followed at our centre to ensure the best outcome.
Use of SPINAL CORD STIMULATION involves thorough understanding of the system by the patient. SPINAL CORD STIMULATION uses a small implanted device—called a pulse generator or receiver—to generate low-level electrical impulses that stimulate targeted nerves along the spinal cord. This stimulation interferes with the transmission of pain signals to the brain.
There are two main components of the system implanted in the patient’s body.
First a thin wire called the lead is positioned in epidural space above spinal cord.
Second, is the implantable pulse generator or IPG [similar to cardiac pacemaker]
which is placed just under the skin in a practical location that is acceptable to you and your doctor; and the leads are connected to the IPG or receiver. When successful, SPINAL CORD STIMULATION replaces painful sensations with a more pleasing tingling sensation called paresthesia.
The success of the therapy involves titration with multiple programing options set by the physician to obtain optimum control of the pain. The patient is able to swap the programmes and adjust the level of stimulation tailored for different pain areas, at different times of the day with the help of a special handheld device like a remote control paired with the IPG.
We have several patients who have undergone spinal cord stimulation for pain of different origin, these includes, post cervical laminectomy pain, CRPS II, brachial plexus injury pain, back pain radiating to lower limb, etc. The results of spinal cord stimulation surgery varies between indications and between centres. At Jaslok hospital, the spinal cord stimulation procedure is performed jointly by the pain specialist and the neurosurgeon and a dedicated post spinal cord stimulation surgical team assist in programming and rehabilitation of these patients.