Spinal cord stimulators for chronic pain
Spinal cord stimulators (SCSs) are medical devices that have been used in pain management for many years.
Spinal cord stimulators (SCSs) are electronic medical devices implanted under the skin with electric leads around the spinal cord. SCSs electrically stimulate the spinal cord to "replace" pain with a new sensation that is perceived as less painful. Because SCSs require surgery, they are usually reserved for people who have not had success from other pain treatments and who are functionally limited by pain. Failed back surgery, complex regional pain syndrome, and unbearable neuropathic/phantom pain are some examples of conditions that may respond to SCSs. Read HPRC’s InfoReveal on spinal cord stimulators for more information.
Spinal cord stimulators (SCSs) are medical devices that are surgically implanted by a qualified pain physician. Electrodes are placed in the space around the spinal cord called the epidural space. These wires are connected to a control unit placed under the skin. When turned on, electrodes produce a tingling or pricking sensation (called “paresthesia”) that "blocks" some of the pain signals going to the brain, replacing the pain sensation with a less painful sensation. SCSs usually are used when pain is not a symptom of another problem but the problem itself. Because SCSs require surgery to be put in place, they generally are used when most other treatments have not worked, such as for “failed back surgery syndrome.”1 The U.S. Food and Drug Administration has approved SCSs for various pain conditions such as failed back surgery and complex regional pain syndrome.
There are three main parts to SCSs: (1) The pulse generator produces the electrical signals. It is surgically implanted in the lower abdomen or buttocks area. (2) Wires go from the pulse generator to the electrodes around the spinal cord. Surgeons choose the placement of electrodes depending on the location of the pain. (3) The control unit allows the user to adjust the stimulator as needed.
What We Know
SCSs have been used for pain management for many years. Below are some studies that describe how SCSs are used in chronic pain management:
- More than 70% of people with hard-to-treat back pain had less pain, less disability, and better sleep after SCS implantation.2
- SCSs work well3 and are cost-effective4 in the long term for failed back surgery syndrome, complex regional pain syndrome, phantom limb pain, some types of chest pain, and pain related to tissue damage in the legs.5
- SCSs also may be helpful for neuropathic pain.6
- SCSs may improve abdominal pain, pain on the inside of the body (visceral pain), and chest pain not related to a heart attack.7
Military-specific research findings on SCSs include:
- Six out of ten active-duty military service members reported less opioid use and improved “compliance with physical therapy” and, in the short term, were more likely to stay on active duty after getting SCSs for complex regional pain syndrome.8
- Military health providers at Fort Bragg found that SCSs were helpful for six Warfighters at reducing pain for problems such as failed back surgeries.9 These Warfighters then completed deployments, meaning that SCSs were used successfully in theater.
The American Association for Neurosurgeons has a good overview of SCSs and their risks. There are risks to SCS surgery such as allergic reactions, bleeding, headaches, infection, paralysis or weakness, spinal fluid leakage, and worsened pain. SCSs also may malfunction, stop working, or only work intermittently, requiring another surgery.
In addition, minor surgeries might be required to replace pulse generators or batteries as they wear out over time. However, some newer batteries are rechargeable10, reducing the need for extra surgeries. The placement of the electrode can stimulate the wrong location or produce overstimulation, causing side effects. SCSs also can interact with other electrical and/or radio-controlled equipment or limit the ability to get medical scans such as MRIs.
Debrief (Military Relevance)
The military and VA have recently expanded the use of SCSs. A video from Fort Bragg explains the use of SCSs in the military and shows SCS surgery. Another video has testimonials from soldiers whose pain has been improved with SCS treatment. In addition, the Army has been using SCSs for pain, including on injured troops returning to Landstuhl Regional Medical Center. For more military-specific findings in pain management treatments, check out the Defense & Veterans Center for Integrative Pain Management's website.
Note: This InfoReveal is an educational overview that describes the use of hypnosis as a strategy for pain management; it is not a comprehensive review of the current state of the research.
This InfoReveal was created in collaboration with the Defense & Veterans Center for Integrative Pain Management.
- Stojanovic MP, Abdi S. Spinal cord stimulation. Pain physician. 2002;5(2):156-66.
- Van Buyten JP, Al-Kaisy A, Smet I, Palmisani S, et al. High-Frequency Spinal Cord Stimulation for the Treatment of Chronic Back Pain Patients: Results of a Prospective Multicenter European Clinical Study. Neuromodulation : journal of the International Neuromodulation Society. 2012.
- Jeon YH. Spinal cord stimulation in pain management: a review. The Korean journal of pain. 2012;25(3):143-50.
- Bala MM, Riemsma RP, Nixon J, Kleijnen J. Systematic review of the (cost-)effectiveness of spinal cord stimulation for people with failed back surgery syndrome. The Clinical journal of pain. 2008;24(9):741-56.
- Nizard J, Raoul S, Nguyen JP, Lefaucheur JP. Invasive stimulation therapies for the treatment of refractory pain. Discovery medicine. 2012;14(77):237-46.
- Wolter T, Kieselbach K. Cervical spinal cord stimulation: an analysis of 23 patients with long-term follow-up. Pain physician. 2012;15(3):203-12.
- Falowski S, Celii A, Sharan A. Spinal cord stimulation: an update. Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics. 2008;5(1):86-99.
- Verdolin MH, Stedje-Larsen ET, Hickey AH. Ten consecutive cases of complex regional pain syndrome of less than 12 months duration in active duty United States military personnel treated with spinal cord stimulation. Anesthesia and analgesia. 2007;104(6):1557-60, table of contents.
- Dragovich A, Weber T, Wenzell D, Verdolin MH, et al. Neuromodulation in patients deployed to war zones. Anesthesia and analgesia. 2009;109(1):245-8.
- Hornberger J, Kumar K, Verhulst E, Clark MA, et al. Rechargeable spinal cord stimulation versus non-rechargeable system for patients with failed back surgery syndrome: a cost-consequences analysis. The Clinical journal of pain. 2008;24(3):244-52.