Stimulators are usually used in cases of neuropathic pain, such as occurs after back surgery or with Complex Regional Pain Syndrome, although there are other indications, such as inoperable heart disease and peripheral vascular disease, where it is also useful.
Before having a stimulator implanted, we perform a trial of the device to see if you like it. This trial is very easily performed. The spinal cord stimulator lead is placed into the epidural space very much like an epidural catheter is placed, using just a needle. There is no cutting involved. Trials are quick and easy to do; the only thing which would prolong a trial would be if it takes a long time to locate the precise spot we want to stimulate.
After the stimulator lead or leads are placed, they are secured, with the leads being attached to a programmer that you can wear in a “fanny pack.” You will be given several different programs to use. You should spend the next several days using the different programs, finding out which you like the best.
We limit the length of the trial because we are concerned about the risk of infection if the leads are left in for too long. After your trial is over, you will have your leads removed in our Laguna Hills office. Lead removal is a quick, simple procedure.
If you find that during the trial, the spinal cord stimulator allowed you to function better, then we would proceed to a permanent implantation. Implantation involves placing the leads, anchoring them in your back so that they do not move, and placing a generator. We usually place a generator in the buttock, in the same area where a wallet would rest. Permanent placement is a surgical procedure; you may be uncomfortable from the procedure for up to 2 weeks after the procedure. You will, of course, be given both pain medication and antibiotics. In order to minimize the possibility of your leads moving from their optimal position, we will ask that you avoid activities that might move the leads, like reaching over your head or sitting up in bed. We recommend you roll out of bed.
Sometimes, instead of percutaneous leads inserted through a needle, we will use “paddle” leads, which are placed with a minilaminectomy by a spine surgeon.
Spinal cord stimulators are powerful, important tools in the treatment of pain; although they are not perfect devices. Sometimes, we obtain perfect coverage during the trial; however, despite stimulating the same area, we do not always get good coverage during the permanent placement. This is a frustrating problem for which there is not always an easy answer. Treating chronic pain requires perseverance.