Q&A: Back pain post-surgery? Try a spinal cord stimulator

When even surgery doesn’t ease chronic, debilitating back and leg pain, a spinal cord stimulator can offer relief for many patients, says Jon Geffen, MD, with MultiCare Orthopedics and Sports Medicine.

If you suffer from sciatica, herniated discs or have been diagnosed with complex regional pain syndrome, your doctor or other health care provider may suggest a spinal cord stimulator.

We asked Dr. Geffen some questions about the device, the procedure and who should consider it.

Q: How does a spinal cord stimulator ease pain?

It’s essentially a pacemaker for your spine that decreases spinal pain by stimulating the nerves in your spinal cord. Some people continue to have pain post-surgery, even though there are no more nerves being pinched. This technology interrupts those pain signals. It’s just another way of trying to turn down the volume on your pain.

Q: Who is a good candidate for a spinal cord stimulator?

It’s primarily for people with pain in their spine and in their legs who have had back surgery but are still having pain, especially when other conventional, conservative treatments like physical therapy or corticosteroid injections have not worked, and no further surgery is recommended. There is some evidence that if someone’s had more than one back surgery, they may actually do better with a stimulator than with another surgery.

Q: Shouldn’t surgery be the last resort? Why not try a stimulator before having back surgery?

Surgery comes at a time when the surgeon believes there is no other option to prevent damage or in order to stabilize a spine. The stimulator won’t address leg weakness or numbness. We can use the stimulator after surgery and be confident we’re not covering up something dangerous.

Q: Does it replace the pain with another sensation, like tingling?

The technology has changed significantly in the last 10 years. The older versions worked reasonably well, but this technology works better. Instead of feeling that stimulation like they would have in the old days, they just feel less pain without additional tingling or shocking feelings. Most times you will use settings where you don’t feel extra stimulation at all.

Q: What if I don’t like it or it just doesn’t work for me?

Before we implant this device, we do what’s called a trial. The trial is very noninvasive, similar to the injections people get in their spine. The electrode leads, flexible and thin wires, are secured in place temporarily with an external battery. The patient goes home for about four days and tries it out. So, they aren’t committing themselves to getting the procedure done permanently before doing the trial. It’s just a fantastic way to trial a device. Where else can you try out a medical implantable device?

Q: Is it only for back pain? Or can it also help alleviate pain in the extremities?

It works really well for back pain and pain radiating down a leg caused by nerves in the spine. It’s not often used for arm pain. Most of the time patients with arm pain have carpal tunnel, ulnar nerve injury or a pinched nerve in the neck. Very few people need to get a spinal cord stimulator in their neck, but people do get them.

Q: Is it on 24/7 or can you turn it off?

Mostly it stays on, but it is possible to turn off and even adjust the stimulation with a remote control.

Q: Can you still get an MRI with a spinal cord stimulator? Or make it past airport security?

With most newer units, you can get any kind of medical imaging — even an MRI — with a spinal cord stimulator implanted. Just turn it off first. You will probably set off metal detectors at places like the airport, but you will get a card that certifies you have an implantable medical device.

Q: How do I keep it charged?

It needs to be charged every day for about a half an hour. The charger itself is on a waist belt you plug into the wall. It’s easy to do while watching TV, lying in bed or even reading a book. It typically fits in pretty well with people’s lifestyles. Just sit for half an hour and charge your battery.

Q: Even batteries don’t last forever. How long do the stimulator batteries last and what happens when they stop working?

The data shows that the batteries last longer than 10 years. But when they do wear out, we will just replace the battery. We don’t have to replace the wires. It’s not a highly invasive procedure but needs to be done in an operating room.