What is a spinal cord stimulation trail?



A spinal cord stimulation trial, as the phrase implies, is a temporary installation of SCS technology to evaluate whether the treatment is right for you. It’s the first step in the process.

At the beginning of the trial, you’ll receive a temporary system that’s not implanted. An external trial device is connected to the electrode contact points on your spinal cord. This device emits pulses that restrict the transmission of pain signals.

The spinal cord stimulation trial usually lasts between five and seven days. After it’s complete, the physician consults with you to determine whether to make the SCS installation permanent.

 

Specific steps in the spinal cord stimulation trial

  • The doctor first conducts tests on your response to certain stimuli.
  • Based on your responses, the doctor puts electrodes on the spinal cord, placing them in strategic points that may help the most.
  • The electrodes are connected to temporary wires through your skin, which lead to an external pulse generator. The electrodes are programmed to obscure pain signals to the brain.
  • During the trial period, you’ll monitor your pain experiences and the overall effectiveness of the pulse generator.
  • After the trial period concludes, you and your physician discuss whether to proceed with the permanent placement of SCS technology. If you’ve experienced a reduction in pain by at least 50%, the physician will most likely advise you to go ahead with the permanent procedure. The final decision will be yours.

 

What is a spinal cord stimulation trial preparation plan?

Spinal cord stimulation is a safe and minimally invasive process, but having it done is a major decision that requires thoughtful consideration. These are some pre-surgery steps that guide you through the deliberation and preparation for your SCS trial.

Before consultation: Make a list of the activities your chronic pain prevents you from doing that you’d like to resume. These can and should be specific, even a little mundane: shopping, light exercise, walking, working, traveling — any lifestyle activities you miss.

At consultation: Discuss these goals with your physician. Your doctor will also advise you on the details of the procedure, along with some of the more common risks and side effects that may result.

1 Week before trial: Stop taking non-steroidal anti-inflammatory medication, especially blood thinners. These include Advil, Motrin, Aleve, Naprosyn, and other brands. You should also stop using nicotine products and drinking alcohol, as these substances can cause excessive bleeding.

The day before the trial: Take a walk for 30 or more minutes. Light exercise will help your post-surgery recovery. For lunch and dinner, eat as light a meal as possible.

After midnight on the day of trial: Stop eating food entirely until after the procedure. This also means nothing to drink the morning of surgery, except you may take your prescribed medications (e.g., blood pressure medications) with a sip of water if needed. Some hospitals are now allowing clear fluids until a few hours before surgery – please follow the directions of the individual hospital protocols (if you do not follow the individual hospital guidelines this may result in your surgery being canceled).

On the morning of the day of procedure: Shower with anti-bacterial soap and put on loose-fitting, comfortable clothes. Remove all makeup, nail polish, body piercings, or hairpins, and leave all jewelry or expensive items at home. If your physician has prescribed you medication for the surgery, take it before you leave.

 

How is the device attached to the body?

During the procedure, the physician follows this step-by-step procedure.

Anesthesia. Local or light anesthetics are applied to the area where the injection will take place. You may also choose to be sedated, or your physician may recommend so.

Injection. Using a special X-ray, the doctor inserts a hollow needle in the epidural space, an area surrounding the spinal canal. The needle contains leads, which are insulated wires affixed with electrical contact points. The doctor may perform a light incision to ensure proper placement.

Stimulation. Electrical currents are sent through the electrodes in the first attempt to relieve pain through spinal cord stimulation.

Feedback.We will wake you up for this part of the surgery, the doctor will ask if you feel any pain relief. They’ll ask which specific parts feel the most relief and which areas still hurt. This is a crucial communication process, as it’s used to determine the optimal electrode placement for relieving as many pain points as possible. After this feedback, you’re placed under sedation.

Lead connection. The doctor connects the newly inserted leads into a pulse transmitter, which you’ll wear outside your body (typically on a belt). To hold it in place, the doctor tapes a wire connected to the transmitter on your back.

Recovery. Once the procedure is done, you’ll rest a short while to recuperate.

 

What happens after the procedure?

While you’re recovering, the doctor programs a remote-control device to issue appropriate amounts of stimulation to relieve your pain. This programming is in line with the pain feedback you gave after the connection of electrodes and first stimulation exercises.

As you prepare to leave the medical office, the doctor gives you the remote-control device and advises on its usage. The device is fully adjustable, and you can control the amount, time, and intensity of the stimulating pulses. Some significant, whole-body movements, such as lying down or getting up, may require more stimulation than smaller movements. You can adjust the settings as needed.

It’s highly encouraged that you keep a log during the trial period, noting what settings are used at certain times and the effectiveness of pain relief. If you still feel pain, you should contact the doctor for immediate recalibration of the device.

 

What is a spinal cord stimulation’s typical trial period?

A spinal cord stimulation trial continues for at least five days and can be as long as ten days. Most trials last about a week.

What to expect during a spinal cord stimulation trial

  • The effects of SCS therapy may happen immediately or may take a few days to begin. During the trial, you should be able to resume your everyday lifestyle. You should be able to go back to work or restart the daily routines you may have avoided due to the pain you experienced.Immediately after surgery, patients are encouraged to walk with gradually increased distances. The sooner patients can be active, the sooner he/she may be able to resume their routine.
  • Do not lift more than 5 -10 pounds for several weeks after surgery. This restriction may be increased to approximately 20 pounds after 4 – 6 weeks. Your surgical team will help guide you with your specific lift-ing restrictions after 6 weeks.
  • Avoid prolonged upright sitting on hard surfaces or long car rides (more than 2 hours) for 2 – 4 weeks. It is recommended that patients do not sit for more than about 45 minutes without getting up and taking a 10-minute break and walking.

 

You should be able to resume some of the lighter physical activities you performed before you started suffering from pain — everyday activities like getting dressed in the morning, walking up and down stairs, or standing in one place without fatigue or discomfort.

Some more complex physical activities may be limited or restricted during the trial. Certain body movements, especially heavy lifting, twisting, or bending, may disrupt or displace the leads your doctor implanted. Your doctor will issue a complete list of physical movements or activities you should avoid during your trial.

 

What is expected of the patient during the trial?

A patient’s most vital role during a spinal cord stimulation trial is to track their experience. The doctor may request you keep records of pain relief in various situations, and to note occasions when the pain returns.

Often the physician provides a workbook for you to document the relief you feel during normal, daily activities. The more specific and extensive you can be with this record-keeping, the better the physician will be able to evaluate how you’re responding and what treatment adjustments may be necessary for permanent placement.

One important requirement is to keep the transmitter device and implanted skin areas away from excess moisture. The trial mechanisms are not waterproof and may malfunction if allowed to get wet.  Keep this site dry and do not allow water from a shower to contact this area. Absolutely no soaking in a bathtub while there are external wires coming through the skin.

You’ll be expected to follow all device instructions carefully and use the device as intended. Your physician will provide you with all the information and directions you need for the proper handling of your SCs devices.

 

What happens after the trial?

Once the trial period ends, your doctor will remove the leads. You’ll then discuss the results of your trial, how effective the treatment was, and any issues you might have encountered.

This is the point of decision about whether to continue with SCS therapy with permanent implants, and it’s important to have an honest conversation with your doctor about your experience.

As effective as SCS therapy has proven to be, it’s not a universal solution that works for everybody. The level of relief it provides may not be enough to merit a full installation, or the device may result in some other health complications that would prohibit its use. These effects are why the minimally invasive trial period is necessary before permanent implantation — as simple as the procedure is, it’s still a major life decision.

If you’ve decided SCS therapy works and your doctor agrees, you’ll schedule an operation for long-term implantation.

 

Permanent spinal cord stimulator surgery

Should you decide to move forward with permanent SCS therapy, your doctor will implant a small, rechargeable unit called an Implantable Pulse Generator (IPG). This unit is positioned directly under the skin in a convenient and comfortable place. Most patients are either awake or under light anesthesia during the procedure.

The leads connected to your epidural space near the spinal cord are re-connected to the IPG, which generates electrical impulses through the leads that serve as “pain-maskers.” These signals interrupt the pain messages sent to the brain.

Just like during the trial period, you’ll control the IPG’s stimulation levels with a remote-control device, most likely the same one you used in the trial.

 

What are some things to consider during the trial period?

  • You may feel a measure of pain or discomfort around points in your back where the temporary leads were inserted. These sensations should vanish a few hours after the procedure, or at most a day or two later. Some patients may experience worsening leg pain. These symptoms also should gradually improve with time.

You might also notice some variance in stimulation intensity levels during some activities during the trial.

Although these effects are extremely minor in the vast majority of SCS trials, consider how they may affect you if you decide to have permanent implants.

 

Who may be a viable candidate for SCS surgery

Spinal cord stimulation can address a wide variety of physical symptoms in the back, chest, trunk, and limbs of the body. Some of the specific medical conditions and syndromes SCS can help include:

  • Complex regional pain syndrome (CRPS)
  • Arachnoiditis
  • Phantom limb syndrome or pain after amputation surgery
  • Peripheral neuropathy
  • Radiculopathy
  • Failed back surgery syndrome (FBSS) or post-surgical back pain
  • Angina
  • Spinal cord injuries
  • Peripheral vascular disease
  • Visceral abdominal pain and perineal pain

If you experience any of these conditions — or others as your doctor may advise — you may be considered a good candidate for spinal cord stimulation trial and surgery. Candidates are especially good if they:

  • Have a minimal risk of complications resulting from surgery, or understand the potential risks
  • After multidisciplinary conservative therapies have failed and further neural decompressive surgeries are not indicated
  • Can easily operate the SCS remote device
  • Are over 18 years old
  • Pass a psychological evaluation
  • Are not pregnant

Boulder Neurological and Spine Associates are happy to answer any questions and conduct screening for spinal cord stimulation trials. Contact us to find out more.