This is a procedure that is utilized when all else has failed and pain still persists. The technique is indicated for the following conditions:

• Continued back and/or leg pain after surgery

• Intractable back pain

• Nerve pain due to injury

• Neck/arm pain

• Conditions such as Arachnoiditis and Reflex Sympathetic Dystrophy

The theory is that electrical stimulation from a small electrode placed over the spinal cord will “short circuit” the pain impulses as they travel from the painful area to the brain.

The procedure is done in two steps (or phases). The first phase is the TRIAL phase. Small electrodes are placed under fluoroscopic (X-ray) guidance to ensure exact placement. This is done under local anesthetic with the patient awake. No incisions are made and there is usually very little pain involved. When the temporary electrodes are in place, they are turned on and the patient lets us know if the area of their usual pain is covered by the electrode’s “tingle”. When the electrodes are in the right place, they are taped to the skin and the procedure is over. The patient will keep the temporary electrodes in place for about a week and carry on their usual activities (with some exceptions). They will control the stimulation with a small device the size of a transistor radio. During this TRIAL phase, they will evaluate how much the stimulation decreases their pain. If the benefits are significant, they may elect to enter phase 2.

Phase 2 is the Implantation phase, occurring about 3-4 weeks after phase 1. A spinal cord stimulator system is implanted into the patient. Under local anesthesia, with sedation provided by an anesthesiologist, a small incision is made in the mid-back. The electrodes are placed and then implanted under the skin. At the same time, the battery pack (about the size of a small pacemaker) is implanted into the upper buttock. The system is now completely under the skin. A hand-held device periodically placed over the battery pack will control stimulation.

Refer to the X-ray image of the stimulator in place. (Notice that the stimulator actually is made up of eight small electrodes.) The patient may undergo overnight observation or be allowed to return home the same day. Discomfort is usually minimal.