We’ve all been there.
You bend down to pick up a pencil, you turn the wrong way in a chair or you lift something mildly heavy. Suddenly, a lightning bolt of pain shoots down your spine.
It’s one of the most common ailments in the United States. This year, 50 percent of all Americans will experience some sort of back pain. The same was true last year. The same will be true next year.
But while back pain is the second most common reason for visits to the doctor’s office in the United States, it’s often more difficult to identify a cause as compared to other injuries.
“If somebody is in a car accident and they have a broken tibia, you see it in an X-ray,” says Matthew Karek, MD, an orthopedic spine surgeon with the Spectrum Health Medical Group Spine & Pain Management Center. “That’s often not the case with back pain. There’s a lot of nuance to what we do.”
The majority of Americans who experience back pain can find relief with rest, stretching and simple rehabilitation, Dr. Karek says.
But for those with chronic pain and a negative work-up—an unidentifiable cause of the pain—a rapidly improving technology and simple surgery can often provide relief.
Spinal cord stimulation has been around since the 1980s.
The technology has evolved in recent years, however, to make it a much more effective, convenient and viable option for those with chronic back pain that can’t be repaired by surgery. It’s especially useful when the cause of the pain can’t pinpointed.
The procedure starts with a small device implanted under the skin. The device sends electrical impulses to the dorsal column of the spine, where pain signals travel from the body to the brain. The pulses provide a pleasant tingling sensation that overrides the pain signals.
For many patients, the device severely reduces or altogether eliminates the feeling of pain.
Spinal cord stimulation treats the symptom and not the cause, but for those who have experienced months or years of chronic back pain, that can still make a world of difference.
“(Spinal cord stimulation) doesn’t do anything to alter the underlying course of the disease,” said Jason Squires, DO, an orthopedic spine surgeon with the Spectrum Health Medical Group Spine & Pain Management Center. “But sometimes people have painful diseases or chronic pain, which is stable—it’s not getting better or worse—and we haven’t been able to alleviate the pain that person is feeling. So we use this to alleviate that pain.”
The process works like this: A patient gets a diagnosis of pain. They go to see a pain management physician or orthopedic surgeon or neurosurgeon, but the doctors can’t identify a specific cause or solution.
The pain doctor will then try a temporary spinal cord stimulator and let it run for a week, Dr. Squires said.
The temporary device has some loose-hanging wires, but patients can still go through routine daily activities. The patient can also adjust the frequency and strength of the pulses using a small radio controller the doctor provides.
At the end of the week, the pain doctor asks if the stimulator has helped. If it has reduced the pain by more than 50 percent, the patient becomes a candidate for a permanent device.
The permanent stimulator has no wires. The battery lasts for up to nine years, and the patient must charge it every one to two weeks using another small wireless device.
About 75 percent of the patients who end up on the permanent device see a significant or complete reduction in pain, Dr. Squires said.
“The ones who benefit from the temporary device, they come in and say, ‘It’s unbelievable!’ ‘A miracle!’ ‘I wanted it put in yesterday!’” Dr. Squires said. “The ones who it doesn’t seem to work great for were unsure the temporary one was working, but told the pain doctor it did work because they were desperate and hoped it worked better than it actually did. But usually if the temporary one works well, the patient will have a lot of success with the permanent one.”
The implementation of the device is usually done as outpatient surgery. It takes about 45 minutes to an hour with little blood loss, low infection rates and little risk to the spinal cord.
“Most people, a month or so out from the surgery, are feeling pretty much recovered,” Dr. Squires said. “The technology has continued to evolve and really come a long way. It’s not really comparable to anything we had before.”