What is pain?


Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. While pain is a symptom, it can become a disease if left untreated.


SPINAL CORD STIMULATION IS A NON-OPIOID ALTERNATIVE

Spinal cord stimulation or “SCS” offers a non-opioid, FDA approved alternative for chronic pain treatments when other therapies such as physical therapy, medication, injections, or surgery have failed.

HOW DOES IT WORK

SCS blocks the pain signals traveling between the spinal cord and the brain. Stimulation is delivered by a neurostimulator energy source that sends impulses from the device to the spine over thin insulated wires called leads. The leads have contacts which deliver mild electrical impulses to an area near your spine to interrupt pain signals between your spinal cord and your brain.


WHAT ARE THE RISKS

Risks include infection, lead movement, pain at the implant site, and loss of effectiveness.


THE TRIAL

The spinal cord stimulation (SCS) is an option to try prior to committing to the implant. This experience helps you understand how well the neurostimulator may relieve your pain during different activities and while you sleep. It is important to discuss your therapy goals with your physician by creating a list. The external neurostimulator sends mild electrical impulses through the temporary leads to the nerves near you spinal cord. During the trial, you are able to use the therapy programmer to adjust the stimulation, allowing you to control the different levels and programs of stimulation the system offers.

The trial lasts up to 7 to 10 days. Afterward, you will visit your doctor and have the temporary leads removed to decide if SCS is right for you.


GENERAL STEPS OF THE TRIAL PROCEDURE:

  1. The doctor places temporary leads (thin and flexible wires) near your spine using x-ray guidance. The area will be numbed with a local anesthetic.

  2. The leads are connected to an external wireless neurostimulator, which will be secured to your back during the trial.

  3. In the recovery room, your device will be programmed to find a setting to determine the therapy that may work for you.


THINGS YOU’LL LEARN AFTER THE PROCEDURE:

  • How to use the handheld therapy programmer

  • How to care for the area around the leads

  • Activities and movements to avoid during the trial period


You may experience some discomfort on your back where the leads were placed for up to 24 hours. This is temporary and should go away in the hours and days after the procedure. You might also experience some changes in stimulation intensity with certain activities during the trial stage which can be controlled with your handheld programming device.


THE TRY AT HOME TEMPORARY SCS SYSTEM

The SCS trial lasts anywhere from 5 days to 14 days depending on what your doctor decides is best for you. During the trial, consider doing some of the things you would normally like to do and more.


  • The limitations include motions such as twisting and heavy lifting, which may dislodge the trial leads.

  • During the trial you are free to go to work, do your daily routine, and try some activities you’ve been avoiding because of pain.

  • The trial system is not waterproof. We ask that you refrain from letting the system come into direct contact with water when showering or bathing.

  • The results of the trial may be immediate, or they may take a few days.


Potential risks:

A complication may occur during the trial. This includes bleeding into the epidural space, an infection, or other side effects. Do not undergo a trial if you have an active infection requiring antibiotics on the day of the procedure.




THE NEXT STEP — A PERMANENT IMPLANT

On the return visit to the office, this marks the end of your trial period where the temporary leads will be removed in the office.

  • Your doctor will discuss your experience with you and together, you’ll decide if an SCS therapy implant is right for you.

  • If you and your doctor agree SCS therapy is right for you, you’ll schedule the procedure approximately in 2 to 4 weeks.


THE PROCEDURE

The implant procedure is similar to the trial procedure except, new leads will be placed in the same location near your spinal cord. In addition, the neurostimulator will be permanently implanted under your skin. The procedure is usually done in a hospital or surgery center as an outpatient. The procedure itself takes about 1-2 hours.


POST PROCEDURE

After the surgery, you will have incisional pain for approximately 5-7 days and pain medications will be prescribed for the short duration. Antibiotics will also be prescribed to reduce the risk of infection. During this time,  you will be advised that you avoid certain activities, including those that involve lifting, bending, and twisting. You may also experience pain at the neurostimulator implant site for up to 10 days.

Once the procedural pain has subsided, your system will be turned on at the first follow up visit with your doctor to ensure that it’s working correctly. There are many stimulation settings available to help alleviate your pain. Your doctor will help you find the settings that are right for you.


FOLLOW-UP

Follow-up appointment after surgery is approximately 7 to 14 days after implant and 4 weeks after that. These are the postoperative visits to inspect incisions, change dressing, and lift the restrictions. Initially the neurostimulation system may require more frequent adjustments to meet the similar results as the trial period. These first few postoperative visits will be to adjust and personalize your therapy to achieve the best pain relief. You are in control of your stimulation, to make sure the therapy is meeting your needs.


THE RISKS AFTER IMPLANT

The SCS implant process requires surgery which can have complications. Once the neurostimulation system is implanted, it’s possible that device complications may occur. Some of these complications include infection, bleeding into the epidural space, pain after surgery, and a risk of lead migration.




“My mission is to help alleviate pain and suffering to patients by offering the most up to date and innovative therapies.”



Peripheral Nerve Stimulation

Peripheral Nerve Stimulation provides long lasting pain relief by blocking pain signals from reaching the brain. Nerve related pain is blocked by delivering a week electrical pulse through a small electrode which is placed with ultrasound guidance over the affected nerve. This therapy can be used to treat CRPS, occipital neuralgia, peripheral neuropathy, and other painful nerve injuries. 


Intrathecal Drug Delivery

Targeted drug delivery is a safe and effective way to manage chronic pain or cancer pain with fewer side effects and lower drug doses compared to oral pain medications. Effective pain control is achieved by delivering medication directly to the surrounding spinal cord by means of a programmable drug reservoir. After a successful trial, the drug pump and catheter are implanted beneath the skin. Medication doses are adjusted through a programming device and patients can deliver medications when programmed by your doctor.


Indirect Spinal Decompression

Lumbar spinal stenosis is when there is narrowing of the spinal canal due to degenerative changes of the spine. Narrowing may cause pain, numbness, tingling, weakness, and difficulty walking. Indirect spinal decompression, or the vertiflex procedure is the placement of a spacer device that is implanted in between the spinous processes of the lumbar spine to relieve the pressure on the nerves and to reduce the pain. This procedure is performed in an outpatient setting and the patient goes home the same day of the procedure.


Radiofrequency Ablation

This procedure uses cooled radiofrequency energy through a probe to safely target the sensory nerves responsible for sending pain signals. A radiofrequency generator transmits a small current of RF energy through an insulated electrode, or probe, placed within tissue. Ionic heating, produced by the friction of charged molecules, thermally deactivates the nerves responsible for sending pain signals to the brain. RF energy heats and cools the tissue at the site of pain.


Radiofrequency can help treat pain located in the neck, low back, knee, hip, and shoulder.


Regenerative Medicine: Platetlet Rich Plasma (PRP) and Bone Marrow Aspirate Concentrate (BMAC)

PRP stands for platelet rich plasma and BMAC stands for bone marrow aspirate concentration. These therapy may be used to treat various acute and chronic pain conditions such as rotator cuff tear, tendonitis, muscle tears, sprain, trigger points, meniscus tear of the knee, mild to moderate degenerative arthritis of various joints, disorders of the spine especially facet joints. Your own blood is used to promote cellular repair. PRP and BMAC contain growth factors, platelets and other molecules from your own blood which help the body with healing.  The natural healing takes place with the help of certain blood products such as platelets, neutrophils, monocyte macrophage, fibroblasts, endothelial cells. For PRP, approximately 15 mL of blood will be taken from your vein, and for BMAC arrproximately 40-60mL of blood is taken from the bone marrow. Blood is placed into a centrifuge to concentrate the healing components. Under sterile technique, local anesthetic will be used to numb the skin and the area of injection, and ultrasound or x-ray imaging will be used to inject the PRP or BMAC. Following needle removal, you will rest for 15 minutes in the exam room.


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