Safer relief options for back-pain patients
Spinal-cord stimulation help patients in Vancouver ditch addictive opiates
Rebecca Clements has finally found relief from the disabling, chronic back pain that has plagued most of her life, thanks to an implanted neurostimulator that delivers electrical impulses to block pain signals to her brain.
Clements, a 55-year-old Vernon, B.C. resident whose severe pain was triggered by a fall as a teenager, has had two operations at Royal Columbian Hospital in New Westminster, B.C. on herniated discs, but neither provided relief from her unrelenting pain. A few car accidents exacerbated her misery, she said.
Physical therapy, surgery, medications, lidocaine injections and nerve blocks are just some of the strategies to control pain. But, if those fail, spinal-cord stimulation is another option gaining popularity. It involves implanting electrodes on the spinal cord to control pain signals. The electrodes are attached to a rechargeable, battery-powered stimulator. Individuals suffering from chronic pain, mainly in the back and limbs, are considered candidates as are those who haven’t gotten relief from back surgery and other interventions.
Clements said she tried injections and painkillers, including opiates.
After decades of suffering, she was finally referred to Jill Osborn, an anesthesiologist and pain management specialist at St. Paul’s Hospital in Vancouver, Osborn suggested Clements consider spinal-cord stimulation that involves implanting a neurostimulator that is like a pacemaker for the spine. It’s been demonstrated, in numerous studies, to reduce pain in patients with certain types of chronic pain.
“The last MRI I had before I got the implant showed I had a bulging disc, arthritis, scar tissue around nerves and inflammation,” Clements said. Failed back-surgery syndrome, which is Clements’ diagnosis, along with chronic lumbar pain, are a few of the top indications for spinal-cord stimulation. The stimulators can also be implanted in patients suffering from chronic pain after cancer surgeries like mastectomies.
Osborn proposed a trial of two weeks to see if the stimulator implanted under the skin near Clements’ hip helped. If not, it would be removed.
Patients undergoing the outpatient procedure are given conscious sedation and localized freezing where incisions are made to implant the device and electrodes attached to it in the epidural space of the spinal cord.
Clements said she was enthusiastic about trying the procedure: “From the place I was coming from, or where I was headed, the chance of success was well worth it all. I was basically confined to a couch. I used a cane. I was hardly living and it was getting to the point where I’d have to be in a wheelchair.”
The procedure took place in the spring and Clements said she noticed an immediate effect. “Now I’m off all morphine and I’m being weaned off the other pain drugs too,” she said.
The electrical impulses are subtle and feel like tiny vibrations but settings are personalized and many individuals feel nothing.
“The technology is absolutely incredible and mine is even MRI compatible, although I have to turn the battery off when I’m going through airport scanners or I’ll feel a zap,” Clements said.
Osborn said spinal-cord stimulators have been around for a few decades but their popularity has really surged because of the opioid epidemic and the recognition that some patients who are prescribed such drugs become addicted to them.
“Everyone is nervous about getting hooked on narcotics,” Osborn said, noting that a recent study has confirmed that the stimulators help reduce opioid use. A study published in Neurosurgery this year showed that of 53 patients who were using opioids for uncontrollable pain before their spinal-cord stimulators were implanted, 64 per cent either eliminated or reduced their consumption of such narcotics at the one-year mark.
At St. Paul’s, the devices have been implanted in selective patients for nearly 20 years but the technology is constantly being refined. Besides St. Paul’s, the only other hospitals where such devices are being implanted in British Columbia are in Nanaimo and Victoria. The B.C. government pays for only 28 device implants a year; just under half of which are done at St. Paul’s.
“The government allocates a budget and we have to work within it. We hope it will increase but at the same time, we don’t want to break the medical system bank,” Osborn said.
The devices cost more than $20,000 each, not including physician fees.
Osborn acknowledges that studies have shown that about half of patients will derive pain relief from the devices: “Not everyone is successful, or even a candidate. There are many different kinds of pain patterns and so patient selection is very important so that we get the right patients with the right kinds of conditions.”
Those considered good candidates have a trial period of one to two weeks. If they don’t experience pain reduction of at least 50 per cent, then it may not be worthwhile to leave the device in.