Pain Relief When All Else Fails

Posted on: June 6, 2017

If you or someone you love suffers from chronic severe pain and no methods have brought relief, you need to know about a surgical procedure that can significantly reduce or even eliminate pain. Here, I inform you about spinal cord stimulation for chronic pain. The procedure could change your life. By Dr. Alain C. J. de Lotbinière, CM, FACS, FRCSC, Medical Director of the Cancer Treatment & Wellness Center and Co-Medical Director of the Gamma Knife Center, Northern Westchester Hospital (NWH).

Dr. de Lotbiniere

The Spinal Cord Highway — Where’s the Pain-Free Exit?
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.

Medication-Resistant Pain?
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. They have run out of other options. As part of my consultation, I perform a psychological assessment, since people who are emotionally distraught or depressed because of pain can develop a psychosomatic condition of chronic pain, which responds best to psychiatric care.

Gearing up for Pain Reduction
Step one is a trial typically 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. By continuously asking whether the tingling the patient feels as stimulation is increased matches the area of the pain, the doctor finds the sweet spot where the electrode must be placed.

Once the electrode is correctly placed, the patient is sent home to monitor its effect. If pain is reduced by 50 percent or more, the trial is a success and the patient is now a candidate for permanent placement of a simulator. I perform this second procedure, which takes about an hour and usually involves an overnight stay in the hospital. Post-surgery, the stimulator is individually programmed, and over the course of several sessions with me, it is increasingly fine-tuned to provide the greatest pain reduction. I tell patients that from now on, you must look at yourself as a violin. You must keep yourself tuned up.

Special safety measures are taken during the procedure to avoid damage to the spinal cord. We are introducing an object into a relatively tight space and need to be sure it is not impinging on the cord. In addition, extra steps are taken to reduce the chance of infection due to the insertion of a foreign object into the body.

The Results Are In…
Patients have different responses, with most people enjoying pain relief. 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, then turned back on, in the hope of renewed effectiveness. For a minority, the procedure is a failure. The battery life in today’s implants lasts for about ten years.

I remember a patient in his 40s, who went to Las Vegas with his wife for a vacation. He was standing on line at the buffet, when suddenly, one of the trays with a burner to keep the food hot exploded, scalding his arm. The man developed complex regional pain syndrome, which is an aberrant response to injury (most common in women) in which even after an injury resolves, pain radiates from the area to other parts of the body, all becoming so painful that these areas can’t be touched. In this case, the man’s entire arm remained so intensely painful, it couldn’t be touched, and had to be kept covered to protect it from contact. Nothing provided relief until the insertion of a spinal cord stimulator. Then the pain subsided and the patient regained use of his hand. He is now doing very well.