One or two trial leads are placed through the skin into the epidural space. Trial screening is performed on all patients before permanent implantation. Patients who are taking blook thinners (and cannot be safely taken off these medications) or those who have bleeding disorders.Patients with weakened immune systems that could put them at greater risk for infections.Patients suspected of having an active infection.Implanted pacemaker, cardioverter/defibrillator.Patients who are not able to understand use of the stimulator (dementia, Alzheimer’s disease).There are no contraindications to implantation.Psychological clearance has been obtained.Surgery would not be indicated in treating pain.Conservative management as indicated above has been ineffective.Which patients are considered candidates for SCS? In general, SCS is more effective in patients with nerve pain on one side. Other indications include peripheral vascular disease, refractory angina, radiculopathies, neuropathies, and phantom limb or stump pain. The most common indications in the United States include failed back surgery syndrome and complex regional pain syndrome (formerly known as reflex sympathetic dystrophy). SCS is used in a variety of chronic pain conditions.
Stress management and behavioral programs.Nerve blocks and interventional management.Physical therapy, spinal manipulation and TENS units.Medical management with anti-inflammatories, muscle relaxants, low dose anti- depressants and anti-convulsants.The following is a list of treatments that have usually been tried before SCS: Patients will have undergone conservative therapy before SCS is considered. SCS is NOT a first line treatment for chronic pain. What sort of treatment has been given before considering SCS? Failure to respond to the TENS unit does not predict your response to SCS. TENS is most effective in acute pain control while SCS is used for chronic refractory pain. TENS is an external system that delivers electrical energy to the skin. SCS is an internal, implanted system that delivers low voltage electrical stimulation close to the spinal cord. How does SCS differ from a TENS (transcutaneous electrical nerve stimulation) unit? Closure of this gate helps to block incoming pain transmission from the periphery and spinal cord. The lead is connected to an implanted long life battery or a receiver that receives energy from an external battery.Īccording to the “Gate Control” theory of pain, SCS is thought to activate the body’s pain inhibitory system. Electrical stimulation is delivered through an implanted lead superficial to the spinal cord in the epidural space. Spinal cord stimulation delivers low voltage electrical stimulation to the spinal cord to block the sensation of pain.
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