Medical Advances in Pain Management

What's New? What'sOld? What's improved?

This page offers information which I think is relevant to most Pain Patients.  If you have a question or a specific topic you would like to see covered you can e-mail me or post a message on the board.  I will do my best to get the answer.

Topic 1

SPINAL CORD STIMULATOR [SPS]

Since no single therapeutic method is effective for every patient, many therapeutic approaches are attempted for the relief of chronic nonmalignant pain.  This type of pain is difficult to define.  The workining definition is that it occurs almost daily, has lasted for 6 months or longer, and may continue for the remainder of the patients life.  Methods used to attempt relief are opiod analgesics, relaxation methods, biofeedback, nerve blocks, transcutaneous electrical nerve stimulation [a TENS unit] and a spinal cord stimulator [SCS] just to name a few. 
      Currently , SCS is accepted as a valuable therapeutic alternative in the treatment of chronic pain that has failed to respond to other methods, and is used to treat many types of nonmaglignant pain. Patient selection is a major factor in achieving favorable success rates.  Numerous studies have established the success rate of SCS between 15% and 88% with the majority over 50%
      SCS is beneficial for patients with chronic intractable pain.  Careful selection is crucial, with criteria for selection including failure of consertive therapies, further surgery inappropiate, no drug habituation problems, a thorough psychological consult, pain due to an organic cause [ radiating pain is the major symptom], a trial stimulation has been successful, and there are no contraindications such as infection or coagulopathy.  Patients must understand that there are limitations to SCS, and that it will not remove the source of pain: but it may reduce the pain experienced.
      Depending on the manufacturer, implantable leads differ in design and configuration. However, system components are standard.  A 2 stage procedure is used for SCS implantation.  The first stage is a trial implantation, while the 2nd stage is the permanent implantation.  The electrodes are placed percutaneously under local anesthesia, heavy sedation, or general anesthesia with the patient in the prone position.  The best results have been shown under local anesthesia.  The electrodes are usually located between the T9 and T11 vertebrae for lower extremity pain.  The transmitter is turned on and test stimulation is conducted in an effort to match the stimulation pattern of the patients pain distributation.  An evaluation of the effectiveness of pain relief is recorded.  If the trial period provides at least 50% analgesia, the system is then permanently implanted surgically.

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