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Written by

Professor Harald Breivik Harald Breivik is emeritus professor of anaesthesiology, University of Oslo; consultant at the department of pain management and research, Oslo University Hospital, Oslo, Norway; and editor-in-chief, Scandinavian Journal of Pain

Non-pharmacological pain treatment: spinal cord stimulation

Published 2 May 2017

Spinal cord stimulation is a well-established method that can relieve pain in a number of conditions. However, it is difficult to predict the response in a particular patient, says pain expert Professor Harald Breivik


What is the role of a non-pharmacological pain treatment like spinal cord stimulation, in the treatment of pain?

Spinal cord stimulation (SCS) is a well-researched, clinically well-established method that can relieve pain intensity in a number of pain conditions and pain locations. The following are pain diagnoses in which SCS can have pain-relieving effects: chronic neuropathic pain, ischaemic limb pain, failed back surgery syndrome and even complex regional pain syndrome (CRPS).1,2

SCS does not help every patient that tries it, and it is not possible to predict the effect in a particular patient.3 It is necessary to place the electrodes optimally, so that electrical stimuli can elicit paraesthesias in the limb or in the area of the pain.

Thereafter, the patient will practice using the stimulator, with a number of stimuli-modulations. Only when the patient is convinced the pain relief is sufficient to make a difference for pain intensity and quality of life, is the SCS-equipment internalised and the wound is closed.

Possibly more effective than traditional SCS are the new 10k high-frequency stimulators, which do not cause paraesthesia.4 The electrodes are placed in the area of most likely effect, the stimulator is turned on and various frequencies and stimulation strengths are tested. Pain relief does not happen immediately, but takes a few hours to a couple of days to become noticeable. Because there is no stimulation-caused paraesthesia, 10k SCS can be studied with randomised, controlled trial protocols.

Unfortunately, there are complications; some are serious such as bleeding or infection and abscess occurring in the spinal canal.5

  • Harald Breivik is emeritus professor of anaesthesiology, Universitetet i Oslo, Norway. He is also editor-in-chief of the Scandinavian Journal of Pain


References

  1. Verrills P, Sinclair C, et al. Journal of Pain Research 2016;9:481–492.
  2. Visnjevac O, Costandi S, et al. Pain Practice 2016 Oct 14. doi: 10.1111/papr.12513. [Epub ahead of print].
  3. De La Cruz P, Fama C, et al. Neuromodulation 2015;18:599–602.
  4. Kapural L, Yu C, et al. Neurosurgery 2016;79(5):667–677.
  5. Eldabe S, Buchser E, et al. Pain Medicine 2016;17:325–336.

Date of preparation: April 2017; MINT/PAEU-17015