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Spinal Cord Stimulation

Learn about Spinal Cord Stimulation as treatment of chronic pain, how it works, who is eligible and what to expect.

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What is Spinal Cord Stimulation (SCS)?

Spinal cord stimulation is a treatment that sends mild electrical signals to the spinal cord, which helps reduce pain by disrupting the pain messages sent to the brain. It’s often used for people suffering from chronic pain when other treatments have not been effective.

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Spinal cord stimulation (SCS) has been used for over 50 years.

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Spinal Cord Stimulation is a well-established and proven therapy for managing chronic pain.

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Spinal Cord Stimulation delivers effective and longlasting pain relief. 1,2

How does Spinal Cord Stimulation (SCS) work?

For spinal cord stimulation to work, a specialized device system is required. The system consists of a small pulse generator, similar to a pacemaker, and thin wires called leads or electrodes. The stimulator (or implantable pulse generator, short: IPG) is typically implanted under the skin, usually in the lower back or abdomen, while the electrodes are placed near the spinal cord in the epidural space.

Diagram showing spinal cord stimulation device with remote control
Spinal cord stimulator implant

Stimulator or Implantable Pulse Generator (IPG)
A small device called a spinal cord stimulator or IPG is implanted under the skin.

Stimulation leads

Leads
Thin, flexible “leads” are connected to the spinal cord stimulator and placed near specific nerves in the back.

Blue stimulation signal

SCS Impulses
The spinal cord stimulator or IPG sends mild pulses through the leads to the nerves.

Red stimulation signal

Pain Signals
The pulses interrupt the pain signals on the way to the brain

Remote control device

Remote control
You can turned ON and OFF and adjusted programs. Rechargeable systems will also include a charger.

Once the stimulator (or IPG) is in place, it sends mild electrical pulses through the electrodes to the nerves in the spinal cord. These pulses modify or interrupt the pain signals before they can reach the brain.

Patients can adjust the intensity of the stimulation using a remote control to manage their pain levels. The system doesn't cure pain but helps reduce the perception of it, offering relief for people suffering from chronic pain.

In this animated overview, you will discover how Spinal Cord Stimulation (SCS) works to effectively manage chronic pain.

What does Spinal Cord Stimulation feel like?

In traditional SCS devices, the pain is masked by a sensation referred to as paresthesia: Instead of pain you might feel a tingling or “pins and needles” sensation in the area where you usually feel pain. Many patients find that this tingling feeling is a good sign that the stimulation is working to relieve their pain.

Some patients may find paresthesia bothersome and distracting. Modern SCS offer 'sub-perception stimulation,' using an unnoticeable lower-level electrical signal. This approach relieves pain without causing the typical tingling sensation.

What types of pain can be treated with spinal cord stimulation?

Spinal cord stimulation (SCS) is most effective for specific types of chronic pain, particularly those linked to nerve damage or certain conditions like Persistent Spinal Pain Syndrome. It’s important to note that not all pain responds equally well to this treatment. For example, SCS is less suitable for conditions like muscle pain or inflammation.

Spinal cord stimulation does not work well for acute pain, from injuries or surgeries or pain from internal organs, like stomach pain. It is also ineffective for headaches, particularly migraines and tension headaches, and for non-nerve-related pain conditions like fibromyalgia.

MRI compatibility with SCS implants: What you need to know

If you have a metallic medical implant, you may wonder if you can have an MRI scan. MRI uses a strong magnetic field that can interfere with implants. However, MRI-conditional devices can be scanned safely with certain precautions.

There are varying degrees of MRI-conditionality across all our stimulators:

  • Our WaveWriter Alpha™ portfolio and Precision Montage™ MRI SCS systems are fullbody MRI conditional. This means that any area of your body can undergo an MRI Scan.
  • Spectra WaveWriter™ and Precision Spectra™ SCS systems are head-only MRI conditional* - this means that MRI scans of the skull can be performed but other body parts cannot be examinded using this technology.
  • Precision Novi™ and Precision Plus™ are not MRI conditional which means that no MRI Scan whatsovever can be performed.

* The Precision Spectra™ or Spectra Wave Writer™ SCS System with ImageReady™ MRI Technology is “MR-Conditional” only when exposed to the MRI environment under the specific conditions defined in the ImageReady MRI Guidelines for Precision Spectra or Spectra WaveWriter Spinal Cord Stimulator Systems.

Step-by-step guide to spinal cord stimulation: Understanding the trial and implantation process

Every journey begins with the first step and so does the path to Spinal Cord Stimulation. In the following section, you will find a detailed overview of each step in the process, from the initial consultation to post-implant care.

The journey begins with a consultation with your doctor, who will evaluate your pain and discuss whether spinal cord stimulation is a suitable option for you. They will explain the benefits and risks, and if you’re a candidate, you’ll move forward to the trial phase.

The trial phase determine if SCS can relieve your pain. Under local anesthesia, a thin lead (a small wire) is placed near your spinal cord and  connected to a temporary pulse generator, worn outside the body. The trial  lasts 5 to 7 days, during which, you monitor your pain relief and report your experiences to your healthcare team. If you experience significant pain relief, you can proceed to the next phase.

A permanent lead will be placed in the same location as the trial lead and  the pulse generator wil be implanted in your body, typically in the lower back. After surgery, you’ll spend some time in a recovery area. Most patients go home the same day.
You will be provided instructions on how to care for the incision site, manage pain, and gradually resume normal activities.

After your recovery, you will return to your doctor’s office to adjust the settings on your SCS device. This may take a few visits to find the optimal settings for your pain relief. You may feel some discomfort or a tingling sensation as the device is adjusted. The goal is to maximize your comfort and minimize your pain.

Regular follow-ups with your healthcare team in the first year post-implant are essential to monitor your pain management and the device's performance. Your doctor will help you with any concerns and make adjustments as needed.

Am I a candidate for spinal cord stimulation? Key criteria and considerations

If you're considering spinal cord stimulation (SCS) as a treatment option for chronic pain, understanding the criteria for candidacy is important. Here are key factors that can help determine if SCS is a suitable choice for your needs.

To begin, your doctor will conduct a thorough medical evaluation. This includes a detailed history of your pain, previous treatments, and any underlying health conditions.

You will likely need imaging tests, such as MRI or CT scans, to help visualize the spine and assess any structural issues that may be contributing to your pain. These tests provide your healthcare team with essential information to determine if SCS is appropriate for your specific situation.

A psychological evaluation is crucial to identify mental health issues that could affect SCS treatment success. It ensures you are emotionally prepared and that SCS will help with pain management.

Insurance Considerations

Spinal cord stimulation can be available through the NHS if it is deemed medically necessary. Patients usually need to go through a referral from a specialist and may need to meet specific clinical criteria.

The National Institute for Health and Care Excellence (NICE) recommends Spinal cord stimulation as a treatment option for adults with chronic pain of neuropathic origin who:

  • continue to experience chronic pain for at least 6 months despite appropriate conventional medical management, and
  • who have had a successful trial of stimulation as part of the assessment specified in recommendation

Spinal cord stimulators are reimbursed through the Specialised Services Devices Programme and reimbursed centrally by NHS.

Coverage for SCS varies among private health insurers, and patients should review their specific policies for details.

Determining if spinal cord stimulation is the right treatment for you involves medical assessments, imaging tests, and psychological evaluations. If you meet the criteria, it may help manage your chronic pain. Discuss your options and concerns with your doctor to make the best-informed decision.

Recovery and lifestyle adjustments after a spinal cord stimulator implantation

Recovery from a spinal cord stimulator implant typically takes a few weeks. You may experience some discomfort around the implant site. Follow your doctor's instructions on wound care and activity restrictions.

Avoid strenuous activities like heavy lifting or twisting initially. Once healed, most patients can return to regular routines, with considerations for activities like driving and swimming.

You’ll generally be able to drive again after recovery, but it’s recommended to turn off the stimulation while driving, as sudden changes in sensation may affect your concentration or comfort.

Swimming is allowed once your incisions have fully healed, though it’s important to confirm with your doctor. Make sure to keep any external device components, like the controller, dry and away from water. 

Boston Scientific advises against the use of an SCS system in a hyperbaric chamber or while scuba diving. No specific tests have been performed to guarantee the devices will function as intended or be safe under these conditions.

Device Management: You can easily manage the spinal cord stimulator using a remote control to adjust settings for pain relief throughout the day. You can switch the stimulation on or off based on your activity level and comfort.

For more information on lifestyle adjustments and managing your device, we collected resources and helpful tips here.

Success rate of spinal cord stimulation

Spinal cord stimulator (SCS) implants have shown success in helping patients manage chronic pain, particularly for those who have not found relief through other treatments. Studies suggest that 50% to 70% of patients experience significant pain reduction after the procedure3.

Studies with the Wavewriter™ Alpha SCS System by Boston Scientific showed an even better result with almost 90% success rate as well as significant and sustained pain relief:

Level I COMBO
Randomized Controlled Trial¹

Randomized Controlled trial

Combination Therapy using the Contour™ Algorithm achieves a higher level of clinical success.

Wavewriter
Real World Study²

Long term pain relief study

The Wavewriter™ Alpha SCS System delivers excellent durable outcomes in the real-world.

The success rate often depends on factors like the type of pain, the patient’s overall health, and how well the device is adjusted to meet individual needs. Many patients report improved quality of life and reduced reliance on pain medications after implantation.

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References:
1. Wallace MS, North JM, Phillips GM, et al. Combination therapy with simultaneous delivery of spinal cord stimulation modalities: COMBO randomized controlled trial. Pain Manag. 2023;13(3):171-184.:
2. Metzger C, Hammond B, Pyles S, et al. Three-Year Outcomes of a Large, Multicenter, Real-World Study Utilizing an SCS system with Combination Therapy. Neuromodulation: Technology at the Neural Interface 2023; 26(4):20. doi 10.1016/j.neurom.2023.04.032.
3. Stojanovic MP, Abdi S. Spinal cord stimulation. Pain Physician. 2002;5(2):156-166.

 

This material is for informational purposes only and not meant for medical diagnosis. This information does not constitute medical or legal advice, and Boston Scientific makes no representation regarding the medical benefits included in this information. Boston Scientific strongly recommends that you consult with your physician on all matters pertaining to your health.

CAUTION: The law restricts these devices to sale by or on the order of a physician. Indications, contraindications, warnings, and instructions for use can be found in the product labelling supplied with each device or at www.IFU-BSCI.com. Products shown for INFORMATION purposes only and may not be approved or for sale in certain countries. This material not intended for use in France.