These are some of the commonly asked questions about this therapy option to help guide a more detailed conversation with your physician.
This is the use of a small medical device that is implanted underneath the skin into the epidural space to stop the pain signals that may be traveling from your neck/back and arms/legs. The device is NOT placed directly into or onto the spinal cord rather is placed in the epidural space (Same location as a labor epidural during pregnancy). It is important to recognize here are a variety of different devices available to patients produced by different companies. Each has their own benefits. Our practice is unique in that we offer all of the major devices to our patients compared to others that may exclusively use one company. Discuss which is best for you with your physician.
This procedure has a growing number of indications though classically it was utilized in the treatment of lumbar back and sciatic nerve pain that persisted despite conventional back surgery. More recently, the indication for this therapy has greatly increased. This can now be considered for patient's that have not yet had any back surgery. Additionally, it is FDA approved for the treatment of painful diabetic nerve pain.
The goal of stimulation is to interrupt the pain signal as it travels to your brain. It offers a more long-lasting approach through sterile implantation of a small catheter under the skin into the epidural space. Compared to a steroid injection where the goal is to treat pain with medication that may have to be repeated, the stimulator is continuously working in the background to help with pain symptoms.
In some respects the TRIAL is similar to an epidural steroid injection in that a needle is placed under low dose x-ray, but rather than giving steroid medication, a catheter which is referred to as a lead is carefully guided into place and taped to the skin after the needle is removed. The IMPLANT is more invasive requiring surgery with 2 small incisions approximately 1.5 inches each to allow the device to be placed under the skin entirely.
The stimulator TRIAL is the opportunity for patients to "test drive" the device before any implant. A TRIAL typically lasts for 5-7 days and is the opportunity for patients to determine if it helps with pain symptoms. During this time, one end of the catheter is in the epidural space and the other end secured externally to the skin with a sterile dressing and tape (similar to a labor epidural for pregnancy). At the end of the 5-7 days regardless of the outcome, the catheter is painlessly removed. ONLY if there is significant pain relief do patients go forward with the IMPLANT which requires surgery to place both the lead and a small battery underneath the skin.
As with any procedure there are risks of bleeding and infection. Please discuss with your treating physician if you are on any blood thinners or have any immunosuppressive disease or taking antibiotics. There is also a risks of nerve injury or damage with needle or lead placement both during the trial and implant.