Spinal Cord Stimulation – a novel therapy to treat chronic back pain

Chronic pain is one of the most disabling problems that can pose significant health, social, and economic repercussions. With September being the Pain Awareness Month, there is a need to raise awareness about the issue that is affecting many in India. Chronic pain is defined as persistent pain lasting more than three months1. Most of the patients end up taking non-prescription medicine or rely heavily on non-steroidal anti-inflammatory drugs (NSIADs).2 Some patients do not believe that analgesics can really relieve pain, or some feel that it is easier to put up with pain rather than their side effects3. Management of chronic pain has become complex due to underreporting, under treatment, and low priority 3. Some studies have shown that up to 23% of the world's adults suffer from chronic low back pain.4 Overall, chronic pain is a condition that negatively impacts the quality of life, and specialized care is indeed the need of the hour.

 

According to Dr Gautam Das, Pain Specialist and Director at Dardia – The Pain Clinic, Kolkata “Back pain is one of the most common complaints of people suffering chronic, debilitating pain, which may be the result of an injury, degeneration, or mechanical issue such as a herniated disc or spinal stenosis. The overuse of pain medications, increased dosage and the growing problem of opioid addiction or overdose has opened up spinal cord stimulation as a feasible alternative to pain relief for selected patients suffering from debilitating chronic pain, particularly intractable back pain.”

 

Spinal cord stimulation (SCS) is emerging as an alternative therapy to treat chronic pain in patients. Successful SCS typically reduces pain by a substantial amount, at least 50%,5 reducing a patient’s reliance on pain medication and allowing them to sleep better, relax, and return to daily activities.

 

Implantable SCS devices are prescribed for treating neuropathy or nerve damage in patients seeking long-term alleviation of excruciating pain. Specifically, SCS devices have primarily been used as a last option for treating chronic, intractable neuropathic pain of the trunk and/or limbs, such as debilitating back, or leg pain typically experienced in patients following back surgery or failed back surgery or due to an accident/injury or disease. In India, this treatment option is gradually taking precedence over standard management for chronic back pain.

A case in point is that of a 65-year-old male patient who had been suffering from back pain and leg pain over the past 7 years. Initially, the pain symptoms persisted on the right side, radiating down to his right leg. After multiple surgeries, physiotherapy and pain killer medications the pain could still not be managed. The burning sensation in the right leg and back was not relieved and the patient felt distress. Post consultation with doctor, the patient’s condition was diagnosed as Failed Back Surgery Syndrome (FBSS).

 

“Failed back surgery syndrome (FBSS) is lumbar spinal pain of unknown origin either persisting despite the surgical intervention or appearing after surgical intervention for spinal pain originally in the same topographical location. Medicine and physiotherapy may not be effective in FBSS, thus SCS was recommended. The Patient significantly benefited from SCS therapy and got a new lease of life,” said Dr Das.

 

Spinal cord stimulation disrupts the pain signals traveling between the spinal cord and the brain, with the aim of giving pain relief. The stimulation is delivered by a neurostimulator, a device (similar in design and function to cardiac pacemakers) implanted under the skin that sends mild electrical impulses to an area near your spine. Spinal cord stimulator implantation is an outpatient procedure. It is done under local anesthesia. A very small incision is made where the power generator is implanted and through a special needle, the electrodes are inserted inside the spine. SCS does not change the body's anatomy and the pain pathway, unlike the surgical method of managing pain.

 

A key benefit of spinal cord stimulation is that you can “test drive” the therapy first, to help the patient and doctor decide if it’s the right fit. The results of SCS depend on careful patient selection, successful trial stimulation, proper surgical technique, and patient education. Stimulation does not cure the condition that is causing pain. Rather, it helps patients manage the pain. Talk with your doctor to fully understand the risks and benefits of any therapy.

 

Disclaimer: “Any and all the Information provided in the article are independent views expressed by Dr Gautam Das, Pain Specialist and Director at Dardia – The Pain Clinic, Kolkata are intended for general overview and educational purposes only. This article is not to be treated as a medical advice. You are required to consult your registered medical practitioner for any clarification around this article”

  

References-

1.    Basics of Pain Management 3rd ed 2022 by Gautam Das, chinmoy Roy, debjyoti Dutta and Kanchan sharma, CBS Publishers New Delhi

2.    Dureja GP, Jain PN, Shetty N, Mandal SP, Prabhoo R, Joshi M, Goswami S, Natarajan KB, Iyer R, Tanna DD, Ghosh P, Saxena A, Kadhe G, Phansalkar AA. Prevalence of chronic pain, impact on daily life, and treatment practices in India. Pain Pract. 2014 Feb;14(2):E51-62. doi: 10.1111/papr.12132. Epub 2013 Dec 4. PMID: 24304963.

3.    Saxena AK, Jain PN, Bhatnagar S. The Prevalence of Chronic Pain among Adults in India. Indian J Palliat Care. 2018 Oct-Dec;24(4):472-477. doi: 10.4103/IJPC.IJPC_141_18. PMID: 30410260; PMCID: PMC6199848.

4.    Casiano VE, Sarwan G, Dydyk AM, et al. Back Pain. [Updated 2022 Feb 22].In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-

5.    Isagulyan E, Slavin K, Konovalov N, Dorochov E, Tomsky A, Dekopov A, Makashova E, Isagulyan D, Genov P. Spinal cord stimulation in chronic pain: technical advances. Korean J Pain. 2020 Apr 1;33(2):99-107. doi: 10.3344/kjp.2020.33.2.99. PMID: 32235010; PMCID: PMC7136296.

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