Spinal cord stimulation is a minimally-invasive procedure that uses an implant to deliver electrical impulses up the spinal cord to interfere with pain signals. Under local anesthetic, the doctor guides a thin, flexible wire with electrical leads on the end into the epidural space close to the site of the pain. A trial stimulator is worn for up to a week, at which time, if the procedure was successful, a more permanent device can be implanted. Spinal cord stimulation is a treatment for chronic back pain that has long been recommended for many complex back pain conditions such as:
- Nerve root compression
- Failed back surgery syndrome
- Spinal stenosis
- Degenerative disc disease
- Sciatica (or any type of radiating back pain)
- Complex regional pain syndrome
- Peripheral neuropathy
Spinal cord stimulation for chronic pain
In a recent study that combined simple economics with pain research, spinal cord stimulation was found to be not only effective at treating chronic pain but also an effective way to decrease the costs of that pain. Principal investigator Nouri Najjar, M.A., a fourth-year Ph.D. student in economics at the University of British Columbia, presented his findings at the Montreal scientific congress this past June, receiving support and accolades for the research from his colleagues.
The study looked at patients who received implants between 2008 and 2013, analyzing their costs and hospitalizations both before and after spinal cord stimulator implantations. The study found that while spending on healthcare increased each of the three years prior to implantation, it decreased in the three years following, for a total decrease in spending of 29%. This decrease indicates the physical and financial efficacy of spinal cord stimulation.
Two of Najjar’s colleagues were also studying the relationship between spinal cord stimulation and healthcare costs, with similar findings. Another of Najjar’s team, physician investigator Alan Berkman, MBChB, DA(SA), FRCPC, FIPP of Nanaimo Regional General Hospital, had this to say about their results:
“This research is a very useful tool to show the funding authority that neuromodulation saves money in the short term with regards to overall health care dollar costs. It has been shown to continue to save money after this period by Kumar. It confirms the value of this very important modality in the treatment of patients suffering with pain.”
Key factors in efficacy
One of the key factors in the efficacy of this treatment appears to be wait times. For patients who waited less than two years for spinal cord stimulation implants, successful relief of chronic pain rates shot up to 75%. Compare this with the rate of patients who wait for 20 years or more after diagnosis (15%), and research is presenting a strong argument for quick, decisive action when it comes to implanting this device. Krishna Kumar, MD, of Regina General Hospital in Regina, Saskatchewan, Canada, took the lead on the study, noting that as wait times declined, success rates rose.
The study also noted significant barriers to access of spinal cord stimulation, including:
- Lack of knowledge among doctors, patients, and insurance companies
- Concerns about reimbursement for the procedure
- Fragmented chronic pain care
The last barrier includes things like care that is not coordinated between clinicians, doctors, and specialists and also care that allows a patient to return to work without being fully diagnosed or treated. This results in recurring flare-ups that are not looked at as another incidence of symptoms for the same condition that might have been successfully treated with spinal cord stimulation.
What the research shows us
In his conclusion, Dr. Kumar noted the importance of his findings:
“Chronic pain is a disease unto itself, which is responsible for physical and psychosocial suffering. The importance of timely treatment must, therefore, be recognized by all physicians. The success of SCS is time sensitive, in that as wait times decline, long-term outcomes with SCS are enhanced.”
As the understanding of the importance of quick action and timely treatment grow, so too does spinal cord stimulation technology itself.
High-frequency versus low-frequency spinal cord stimulation
Researchers, including B. Todd Sitzman, M.D., M.P.H., medical director of Advanced Pain Therapy, PLLC, in Hattiesburg, Mississippi, found that high-frequency spinal cord stimulation using 10 kHz (HF10) worked better for pain relief than lower-frequency, traditional spinal cord stimulation. These findings were presented at the 31st Annual Meeting of the American Academy of Pain Medicine.
Traditional spinal cord stimulation does not relieve the pain so much as replace it with a low-grade tingling or buzzing sensation called paresthesia. In a prospective, randomized, multicenter, comparative trial of the investigational HF10 versus the standard spinal cord stimulation therapy, HF10 eliminated the buzzing sensation and relieved difficult back pain with a higher rate of success for a longer period of time. HF10 is currently seeking approval from the U.S. Food and Drug Administration but is already in use in Europe.
Sitzman and his fellow researchers expect their findings to be crucial to the approval process, noting that:
“These results provide important comparative effectiveness data for healthcare providers and clinically relevant information for pain physicians, patients and payers.”
There are relatively few side effects to spinal cord stimulation, most relating to potential improper placement of the lead in the epidural space. The risk of side effects are reduced when being treated by a qualified pain specialist with experience in this procedure. It is important to understand the treatment, including benefits and risks.
Research increasingly supports the use of spinal cord stimulation for difficult-to-treat chronic pain conditions. Talk to your doctor to see if this treatment option may work for you.
Image by nicoleneu via Flickr