Navid Farahmand, M.D., has subspecialty training and is board certified in interventional pain management. He offers spinal cord stimulation as a way to block pain signals from reaching the brain to residents of Beverly Hills, California, who have suffer from chronic pain.It can be used to treat spine and extremity pain of various etiologies.
Spinal cord stimulation is a procedure in which soft, thin wires with built-in electrical leads are placed behind the nerves of the spine through a needle. A tiny programmable generator is also placed under the skin and is connected to the wires, and acts as a battery delivering electrical current to the wires. The generator can be set to deliver different levels or intensity of nerve stimulation under different conditions. The generator is usually set in the physician’s offices initially, but patients can also adjust the settings at home.
In a nutshell, spinal cord stimulation uses electrical current to send a competitive signal to the brain, which gives the brain an opportunity to focus on a pleasant sensory signal rather than a painful one. This works on the same principle we use, for example, when we rub our foot after it hits the bed post. By rubbing the foot, we send a competitive and pleasant sensory signal to the brain, which makes the pain in the foot less noticeable. Instead of pain, the brain perceives a more pleasant sensation.
Spinal cord stimulation is used to treat a wide range of problems, including persistent spinal and extremity pain following surgery, commonly referred to as “failed back syndrome” or “post-laminectomy pain syndrome.” It is also used for conditions such as Complex Regional Pain Syndrome (CRPS) or Reflex Sympathetic Dystrophy (RSD,) and in Europe has additional approval for refractory chest pain and peripheral vascular disease. The treatment allows patients to perceive less pain, require less pain medication, and to participate more fully in family and work activities. It does not “cure” the actual problem, but it helps relieve the pain.
Before a spinal cord stimulator is actually permanently implanted, patients typically undergo a one-week trial to see if the treatment will help them. The skin is numbed, and the leads are placed behind the spinal nerves in what is called the epidural space; then the leads are connected to a small exterior device (generator) that can be adjusted. The external generator is then turned on and the patient is allowed to experience how the electrical signal feels. If necessary, the position of the wires are adjusted to cover up the patient’s typical area of pain. It usually takes about 45-60 minutes for the procedure. For a permanent spinal cord stimulator, the procedure is similar, except that the generator is permanently implanted under the skin of the buttock or abdomen. This procedure takes about 90 minutes and is usually performed in an outpatient surgery center.