Transcript Spinal Cord Stimulators

Spinal Cord Stimulators
Spinal Cord Stimulation
Therapy
FDA-approved therapy to treat chronic
pain of the trunk and/or limbs
 Used to treat patients with neuropathic
pain
 SCS is considered a third tier pain
therapy
 SCS is not a cure

Pain

Nociceptive Pain

Harmful stimulus is applied to skin, joints,
muscles and nociceptive nerve endings are
activated
 Sharp shooting/ dull aching pain
 Typically lessens over time
 Responds well to traditional treatments

Neuropathic Pain




Arise spontaneously without activation of
nociceptors
Typically Chronic pain
Does not respond well to traditional treatments
Tactile Hypersensitivity- allodynia and
hyperalgesia
How does SCS Therapy work?
Stimulator leads placed along the
dorsal column of the spinal cord
produce paresthesia sensation to help
mask pain signals
 There are 3 types of SCS systems that
can be used depending on the
patient’s pain

 Conventional
IPG system
 Rechargeable IPG System
 Radiofrequency (RF) system
Spinal Cord Stimulator
Procedure
Theories Behind SCS Therapy

Gate Control Theory



Descending Inhibition of Pain pathways


By stimulating the large A beta blocks the
transmission of pain signals via the small C
fibers
Stimulating supraspinal pathways sends signals
up the dorsal column to the brain stem and is
then returned to spinal cord via dorsal
Longitudinal fasciculus to mediate the pain
pathways
Stimulation of the adrenergic sympathetic
neurons close the gate
Stimulation of Dorsal Nerve root fibers
Benefits of SCS
Pain relief
 Reduction in pain medication intake
 Improvement of depression symptoms
 Return to work
 Return to daily activities
 Increase quality of life

SCS Candidates
SCS is a last resort treatment of
chronic pain when other therapies
have failed
 Patients must have a multidisciplinary
screening to determine if they would
be a good candidate
 Successful Trial Placement
 Patients must be motivated and willing
to try the treatment

Successful SCS treatments

SCS has been used since 1967 for the
treatment of chronic pain
 SCS has successfully treated numerous
painful disorders


Failed Back Surgery Syndrome/ Arachnoiditis
Reflex Sympathetic Dystrophy (Complex
Regional Pain Syndrome
 Angina
 Stump Pain/ Phantom Limb Pain
 Peripheral neuropathies
 Radiculopathies
 Peripheral Vascular Disease/ Ischemic Pain
Failed Back Surgery
Syndrome






Pain that persists after one or more surgical
procedure on the lumbo-sacral spine
Most common diagnosis for patients who
receive SCS
Etiology is difficult to pinpoint
Most common cause of FBSS- improper
patient selection
1-10% of patients will be worse after
surgery
Characteristics: back/ leg pain,
numbness/tingling & weakness in legs,
stabbing burning and shooting pain
FBSS Results

Leveque, J et al.
 Randomized
Controlled Trial of 16
patients with FBSS

ANS St. Jude Medical Company Case
Study
 Case
Study of a patient with FBSS
Complex Regional Pain
Syndrome
AKA: Reflex Sympathetic Dystrophy
 Multi-symptom/ Multi-system
 Characteristics:

 Soft
tissue injury/ immobilization
 Temperature difference between affected
and unaffected extremity of at least 1°C
 Tactile hypersensitivity
 Cutaneous changes
CRPS and SCS Research
Results

Kemler, M et al.
 Randomized
Control Trial of patients with
Chronic Reflex Sympathetic Dystrophy

Harney, D et al.
 Review
of case studies with patients with
CRPS treated with SCS
 Overall all SCS groups had a 60-70%
success rate, narcotic intake was reduced
and improvement in activity and quality of
life
SCS and Angina

Number 1 Reason for Spinal Cord
Stimulator implantation in Europe
 Main Clinical Symptoms are related to
ischemic heart pain
 Pain in chest, arms, throat and neck
 Results:



Improved Coronary blood flow but no increase in
totally flow
Altered sympathetic/ parasympathetic balance
Research- Ferrero, P et al., De Jongste et al.
Leg pain

Characteristics
 Pain in leg when walking
 Numbeness/tingling in leg
 Burning pain that is worse at night
 Phantom limb sensation- uncontrollable
movements
 Sensitive Pain

Research
 Jivegard et al.
 Raina, et al.
Questions??
References
ANS: St. Jude Medical Company. (n.d.). Spinal Cord
Stimulation: A Promising Treatment Option for Your
Patients With Chronic Pain [Pamphlet].
Boston Scientific. (2007). Taking Control of Your Pain:
The First Step [Pamphlet]. USA: Precision Plus.
Cameron, T., Ph.D. (2004, March). Safety and Efficacy of
Spinal Cord Stimulation for the Treatment of Chronic
Pain: a 20-year Literature Review. Journal of
Neurosurgery: Spine, 100, 254-267.
Ferrero, P., MD., Grimaldi, R., MD., Massa, R., MD., &
Chiribri, A., MD. (2007, January). Spinal Cord
Stimulation for Refractory ANgina in a Patient
Implanted with a Cardioverter Defibrillator. PACE, 30,
143-146.
Greenwald, T., RN., & Ryan, B., RN. (2004, June). Spinal
Cord Stimulation Overview. In Mayfield Clinic.
Retrieved January 15, 2009, from
http://www.mayfieldclinic.com/PE-STIM.htm
Harney, D., Magner, J. J., & O’Keeffe, D. (2004, June).
Complex Regional Pain Syndrome: the case for Spinal
Cord Stimulation (a Brief Review). Injury: International
References Continued…
Kemler, M. A., MD., Barendse, G. A., MD., & Van Kleef,
M., M.D., Ph.D. (2000, August). Spinal Cord
Stimulation in Patients with Chronic Reflex
Sympathetic Dystrophy. The New England Journal of
Medicine, 618-624.
Leveque, J.-C., Villicencio, A. T., & Bulsara, K. R., MD.
(2008, October). Spinal Cord Stimulation for Failed
Back Surgery Syndrome. Neuromodulation, 4(1), 1-9.
North, R., MD. (2007). Practice Parameters for the Use
of Spinal Cord Stimulation in the Treatment of Chronic
Neuropathic Pain. American Academy of Pain
Medicine, 8(S4), S20-S275.
Raina, G. B., Piedimonte, F., & Micheli, F. (2007).
Posterior Spinal Cord Stimulation in a Case of Painful
Legs and Moving Toes. Stereotactic and Functional
Neurosurgery, (85), 307-309.