Conventional spinal cord stimulators replace pain with mild tingling, termed as paresthesia. New devices provide a "sub-perception" stimulus that cannot be sensed to patients who find such paresthesia unpleasant. Many of the new tools are put under X-ray and/or ultrasound supervision by physicians with specialized training in interventional pain management.

What is spinal cord stimulation?

Stimulating the spinal cord masks signs of pain before they enter the brain. A small device, similar to a pacemaker, stimulates the spinal cord with electrical pulses. This helps people control their chronic pain better and through their use of opioid medications. If an individual suffers from chronic back, leg or arm pain and has not found relief from other treatments, it may be an option.

Chronic pain can occur due to a wide range of reasons. Nearly any nerve injury is capable of becoming a chronic problem. The pain can feel differently, depending on the position of the nerve injury. Trauma to the body and other medical conditions or medicines may cause nerves to be damaged. Many factors that can lead to chronic pain are a pinched nerve in the leg, uncontrolled diabetes, or a medical procedure. The mental health of a person can also play a role in perceiving and managing pain. With several potential causes of chronic pain, it may be very different from another similar patient to diagnose and treat one chronic pain patient.

What are spinal cord stimulation devices?

An implanted device that sends low amounts of electricity directly into the spinal cord to relieve pain is a spinal cord stimulator. Spinal cord stimulators are made up of thin wires (electrodes) as well as a small battery pack (generator) like a pacemaker. The electrodes are placed between the spinal cord and the vertebrae, which is underneath the body, normally around the buttocks or the abdomen.

Spinal cord stimulators enable patients to use a remote control to send electrical impulses when they experience pain. The remote control, as well as its antenna, is kept outside the body. Stimulation of the spinal cord is most widely used after the treatment options for non-surgical pain have not provided sufficient relief. Spinal cord stimulation devices can be used to treat various types of chronic pain or to manage them.

What are the major ailments that highlight the need for these devices?

1. Complex Regional Pain Syndrome

Complex Regional Pain Syndrome (CRPS) is a deteriorating disorder that can be caused by surgery or injury on the limbs. This disorder can complicate recovery and affect the well-being of one's function and psychology. Significant, sustained pain relief and functional progress in CRPS (hand or foot) have been shown to include epidural implantation of a spinal cord stimulator. SCS is an efficacious RSD pain treatment, such as recurrent pain following ablative sympathectomy. The low morbidity of this treatment and its success in patients with RSD-related refractory pain suggest that SCS in RSD management is superior to ablative sympathectomy.

2. Failed Back Syndrome

Failed surgery syndrome (FBSS) is a troubling disorder without curative treatment. Spinal cord stimulation (SCS) has given a satisfactory result in selected patients. SCS is an effective method of pain management in properly selected people with chronic pain who do not have adequate levels of pain control with progressive medical treatments and/or where side effects impede the ability to increase doses of medication for sufficient effect. In various neuropathic pain situations, such as failed back surgery syndrome, its effective use has been depicted.

3. Degenerative Disk Disease

Degenerative disease is an age-related disorder that occurs when one or more of the discs between the spinal column vertebrae deteriorate or break down, and lead to pain. Weakness, numbness, and pain may radiate down the leg. Stimulation of the spinal cord has become a standard of care for chronic back and neck pain sufferers. SCS technological advancements have enabled people with chronic spine-related pain to reduce or remove their need for pain killers and return to comfortable, productive lives.

The future lies in the hands of novelties

While spinal cord stimulation is the most developed member of the therapy family known as neuromodulator, its applications are still evolving. Failed back surgery syndrome is the most common indication for SCS. Neuropathic back and leg pain can often be treated successfully, but it may be harder to treat the related pain component that may have neuropathic and nociceptive etiology. To satisfy this need, a multitude of strategies are being evolved.

Battery technology improvements have enabled the advancement of fully rechargeable implantable pulse generators (RIPGs) as well as non-rechargeable extended-life primary-cell devices. A patient may spend about two to five hours a week charging for charging a device with an induction coil device without discontinuing treatment. Most rechargeable IPGs do not have a finite limit to allow one IPG to last 10 to 25 years depending on the use.

Wireless spinal cord stimulation with nanotechnology in its miniature form does not require an IPG and has been, therefore, devoid of IPG-related costs or complications. Wireless spinal cord stimulation devices only had a 3-year maintenance cost of € 1500, while the result of pain management has been encouraging to date. To improve acceptability and boost indications, larger clinical data could eliminate IPG costs and complications in SCS therapy.