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Spinal cord stimulation devices are most commonly used for the management of pain which is not due to cancer. More recently spinal cord stimulation has been used for a variety of other conditions. Examples of these other conditions include
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Failed Back Surgery Syndrome (FBSS): continued pain after back surgery
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Complex Regional Pain Syndrome (CRPS): condition where there is pain, swelling and difficulties with movement in the limbs
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Extremity pain due to peripheral neuropathy (failure of the nerves carrying information to the brain and spinal cord causing pain, sensory problems and problems with movement), root injury and phantom limb pain (pain in an already amputated arm or leg, as if it were still there)
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Pain due to lack of blood supply in a limb, usually due to diseased blood vessels supplying the limb.
In addition, many other applications of SCS that are being developed and investigated, these include:
- Chest pain in people with heart problems (angina)
- Urinary incontinence (reduced ability to control urination)
- Occipital neuralgia (condition affecting a nerve supplying the scalp causing pain and headaches)
- Interstitial cystitis (condition causing pain in the bladder and the surrounding pelvic region)
Components of spinal cord stimulation devices
Spinal cord stimulation system devices consist of:
- Leads;
- A Generator/Receiver; and
- A Programmer/Transmitter
Leads
The leads are placed in the space above of the spinal column (epidural space). The generator/receiver is also inserted under the skin in a simple surgical procedure. The leads are connected to the generator/receiver. When the generator/receiver's power is turned on, electrical energy is sent through the leads to electrodes that stimulate the nerve fibres associated with painful areas.
The image above illustrates what the device looks like once implanted.
The patient and physician will decide together on the leads that will best suit them. Leads can vary by:
(images above: Percutaneous leads)
Surgical leads (or paddle leads) are larger and require a surgical incision. Surgical leads are that they are less prone to migrate and their flat shape makes them more energy efficient, but they do require a surgical procedure to implant them;
(images above: Surgical leads)
- Number of electrodes - Each lead has at least four electrodes, but a lead can contain as many as 16 electrodes. The number of electrodes used depends upon the complexity of the condition being treated and requires careful consideration by the physician and patient for the most effective pain relief. (Extra electrodes may be implanted in case of difficulties with migration which are easily repositioned if there are extra electrodes.);
- Electrode shape, configuration, and spacing; and
- Length.
Generator/Receiver
There are three types of generator/receivers available for spinal cord stimulation. Each uses a different power source to send the electrical energy to the electrodes. The three types are:
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The rechargeable implantable pulse generator (rechargeable IPG) - is powered by a rechargeable battery and is completely implanted under the skin. How often the battery must be recharged depends on use, it will eventually reach a point where charge will not last long enough for routine activities, such as working a normal job shift or attending a sporting event and the rechargeable IPG will need to be surgically replaced.
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The radio frequency system (RF) power source has two parts - a receiver, which is implanted under the skin, and a transmitter, which is worn outside the body. The transmitter contains a replacable/rechargeable battery, so surgery is not required at the end of the battery's life with this system.
Programmer/Transmitter
A programmer and transmitter are used to program an SCS system and to adjust the intensity of the stimulation. The physician can create up to 24 different programs to accommodate the patient's pain patterns. The patient can choose the program which best suits the pain as it changes throughout the day or as the patient moves or changes positions.
Each type of SCS system has advantages and disadvantages. The patient and physician should decide which system best suits the patient's pain pattern, lifestyle, and how much electrical energy is required to provide adequate pain relief.
The Trial Procedure
Since the effectiveness of the systems can vary from one patient to another and from one area of the body to another, one of the ways to determine which system suits you best is to undergo a stimulation trial. Ideally, the trial should be performed with a full-featured system that lets the patient feel the amount of stimulation and pain relief each type of system provides.
As mentioned above, these devices replace pain with a more pleasant sensation of paresthesia (like pins and needles). If a patient likes the stimulation sensation, and it helps to relieve his or her pain, then spinal cord stimulation is a good option. For some patients, however, the sensation is not pleasant and/or it does not relieve pain. That is why a trial procedure is normally performed to determine how a patient will respond to stimulation.
Use only as directed by your doctor. Discuss any symptoms with your doctor.
Courtesy of: http://www.virtualpaincentre.com/Devices.asp?sid=2
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