What is SCS?
SCS is an intervention for chronic back, leg, arm or chest pain. Its uses include other conditions, such as persistent chest pain, phantom pain of the arm or leg, failed back surgery syndrome, chronic pelvic pain and persistent nerve pain. It can be an effective alternative or adjunct treatment to other therapies that have failed to manage pain on their own. An implantable spinal cord stimulator delivers small electrical signals through a lead implanted in the epidural space. Pain signals are inhibited before they reach the brain. Instead of pain, patients may feel pain relief.
SCS may be:
- An effective alternative when conventional therapies and systemic pain medications provide inadequate pain relief or intolerable side effects
- A reasonable alternative to consider before performing irreversible, neurodestructive surgical procedures
- Considered when there is persistent nerve type pain whereby there is nerve injury or damage.
How is SCS done?
There are 2 parts to the therapy.
Part 1: SCS trial
An externalised trial lead is temporarily “implanted” into the painful nerves in the first part of the trial. This is done under local anaesthesia and sedation. This lead will be connected to a portable external pulse generator. The patient will be given various combinations of electrical signals being sent to the injured nerves. This trial therapy is to mimic the actual treatment should the patient find the therapy helpful with his pain. Over a period of 3 days, the patient will have these different combinations of electrical stimulation to assess how they cover the painful area. If the patient finds that it improves the pain by more than 50% or up to 75%, this is considered a successful trial and we will proceed to part 2.
Part 2: SCS implantation
The entire SCS system, which includes the electrodes, leads, cables and pulse generator, will be implanted into the patient. The entire process will be done under general anaesthesia. All the implants and parts will be implanted under the skin. The pulse generator will usually be placed in the right or left lower flank, so that an external remote controller will be able to communicate with the device to instruct it accordingly. There, stimulation can be used for 24 hours every day to provide continuous pain relief, stopping only for recharge.
The patient will go back to the pain specialist for calibration and monitoring regarding the SCS use. This neuro-modulation treatment will “adjust” the injured nerves and give effective pain relief.
In the newer models, the pain relief can be provided even without the presence of paraesthesia or tingling sensation.