The patient is allowed to awaken from the sedation so that sensations can be verbally reported to the provider team to fine tune the location of the electrical contacts in that overlie the spinal cord nerves. The locations are approximately known through scientific studies that have been previously mapped in humans. With local anesthesia and light sedation provided by an anesthetist in the office fluoroscopy suite, SCS leads will be place via needles into the approximate location that when stimulated with gentle intensity electrical impulses lessen pain in a targeted body part by replacing it with gentle vibration. The trial phase is the first stage of spinal cord stimulation treatment. Common conditions accepted for treatment include failed back surgery, diabetic neuropathy, complex regional pain syndrome (CRPS) and some nerve injuries/diseases that produce neuropathic pain. There are requirements that candidates have optimized mental health treatments, are not misusing or abusing pain medications, and have significant improvements in discomfort and function in life during the trial phase of the treatment. Insurance companies have limited the indications for such treatment so SCS is not available for all cases of intractable pain. Often some improvement is obtained by using neuromodulating medications such as gabapentin, tricyclic antidepressants, or serotonin norepinephrine reuptake inhibitors but the improvement does not allow enough relief or much better function in life’s activities. Spinal cord stimulation works best for pain that arises in nerves whose function has been disturbed such that those nerves continue to send impulses to the brain that are perceived as painful. A control device allows the patient to use as needed and guided by the provider team frequently the manufacturer’s technicians will adjust the device as needed with consultation with PCI providers. The recharging takes place through the skin with the frequency dependent on how it is used. The battery/generator is either rechargeable or long life typically they can last for 10 years before replacement. Before implantation, a patient is asked to go through a trial period with an external device this allows pain levels to be evaluated by a patient to determine whether pain levels decrease when the device is used. SCS does not cure chronic pain, but usually lessens it by 50 percent and more by replacing the feeling of pain with a pleasant vibration or tingling sensation. The device, called a “spinal cord stimulator” or “dorsal column stimulator,” sends electrical impulses through wires/electrodes placed near the spinal cord the impulses block pain signals from reaching the brain. Spinal cord stimulation (SCS) involves implanting an electronic device in the body to help relieve chronic back and leg pain.
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