Chronic Back Pain and Neuro-Spinal Stimulation

Back pain that goes on for a long time can be treated with many types of conservative therapies and even the invasive step of surgery. But the choice of treatment depends on the source of the pain and the duration. The source can be many reasons: physical injury from a car accident, repetitive working conditions like sitting at a desk for 9+ hours a day, over exertion from lifting a heavy object too suddenly, etc. The list of causes is numerous, and for each cause there are just as many possible treatments: rest, prescription medications (for example, anti-inflammatory, muscle relaxing, and pain killing drugs), physical therapy, surgery, and even career changes.

For long-term, chronic back pain that does not respond to more conventional treatment, there is a medical device called a neuro-spinal stimulator. In the 1960's scientists theorized that pain could be controlled if it was blocked by electronic impulses. The introduction of these new pain theories led to research into controlling pain with an electronic device. In the simplest form, the device contains implanted electrodes in the spinal column and wires that connect to an implanted mechanism that can be adjusted to control the strength of the impulses and stimulation.

Before a permanent device can be installed, the patient needs to have multiple tests to determine the exact location of the pain and whether spinal stimulation is appropriate. The testing can be conducted over a series of months and consists of MRIs and multiple nerve blocks in various spinal locations. Depending on the amount of relief the patient experiences from the nerve blocks, the physician can determine the pain source. After the testing is completed, a trial implant is done. Only the electrodes are implanted; the controlling mechanism is taped to the outside of the body. This trial only lasts a few days, but it will tell the patient and medical staff whether the implant is likely to be successful.

If the trial is successful, steps are taken to proceed with the permanent implant. The patient will need the usual pre-surgical tests (lab, x-rays, etc.) and pre-approval from any insurers. Some insurers may require a second opinion, which may take several additional weeks to obtain. When all the pre-surgical requirements are completed, the patient can be scheduled for the implant surgery.

The actual surgical procedure takes about 2 hours. While the patient is awake, the surgeon will use x-ray guidance to position the electrodes in the spine. Then the patient will be placed under anesthetic so the incision for the controlling mechanism can be made in the hip or lower back area. After positioning of the electrodes and mechanism, the two components are connected with wires under the skin. After surgery, the patient is brought back to a recovery area to awaken from the anesthesia.

The recovery period from the surgery is about 9-12 weeks. During this period, the patient may have to wear a rigid back brace, avoid strenuous activities, and sudden bending or twisting movement that could dislodge the electrodes from the spine. This period and the accompanying restrictions allow the tissues in the body to secure the electrodes in the correct position so future activities do not negatively impact the outcome of the surgery.