This is and implantable Device which sends mild electrical Pulses to the Spinal Cord at specific region.
Possible Conditions treated with SCS
- Complex regional pain syndrome (CRPS) / Reflex sympathetic dystrophy (RSD)
- Phantom limb pain
- Brachial plexus injury
- Failed Back surgery syndrome
- Post-Laminectomy Syndrome
- Post thoracotomy neuropathic pain
- Spinal Stenosis not operable
- Post Herpetic neuralgia
- Painful Diabetic neuropathy
- Spinal cord injury with paraplegia
- Occipital neuralgia
- Intercostal neuralgia
- Post hernia neuropathic pain
- Alcohol painful neuropathy
- Any other neuropathic pain
Any disease affecting the spinal cord or the peripheral nerves may produce neuropathic pain symptoms, which can cause sharp, shooting, pricking, burning and/or stabbing pain in the Back, Neck and lower or upper extremities. Pain can be very intense. It can be produced by simple touch, gush of air, brushing of any object to the affected area, movements. It may be continuous or intermittent. There is increased response to a painful stimulus. A simple pinprick may cause an intense pain beyond what would normally be expected.
The stimulation produced by SCS interrupts the pain felt by you. It substitutes pain with a pleasing sensation (paresthesia or tingling).
There are two steps involved namely Trial and permanent implantation.
TRIAL -
This phase is important to find out if you are a right candidate for this therapy. It also allows you to judge if you are comfortable with the the paresthesia felt during trial phase.
Trail of SCS is an outpatient procedure and you may move with the trial system while performing your daily routine.
Parts of SCS -
Electrodes, Connections, Battery (also called IPG) - external or internal and Programmer
Procedure in brief -under local anesthesia, one or more electrode leads are placed in the epidural space through a small introducer needle. The leads are connected to the external battery (portable, external pulse generator). The system generates mild electrical pulses and stimulate the spinal cord. With the help of programmer, our pain physician will set a particular program which best suited for you.The current produces pleasing paresthesia sensation (tingling) and replaces your areas of intense pain.
The trial period may last for a few days to one week. During trial period you can perform daily routine, and all the activities which produces the pain. If your experience good pain relief and tolerable paresthesia sensations you are ready for the permanent phase.
Using the external programmer (Remote control) you can turn the current on and off. You can also adjust the intensity of the current as per the intensity or location of the pain. The system is portable. It is possible to perform most normal daily activities at home and at work. It is also possible to do recreational activities, like swimming, traveling, biking, and gardening.
Once the trial phase is successful and you are satisfied with the pain relief, permanent implantation is performed. It involves connecting the implanted leads to a battery which is implanted in a subcutaneous pocket at pre-decided region (Commonly in lower abdomen, below the clavicle or in the upper gluteal area.
PS - Though SCS is called permanent, it is a reversible therapy. The implanted components can be removed if treatment is not required.
Your ability to enjoy normal family and work activities improves tremendously. Pain reduction can have a positive effect on your psychological, physical health. It reduces stress, and improve overall quality of life.
Newer developments -
There are many newer advances in SCS neuromodulation. Newer techniques like high frequency (HF) SCS, Dorsal root ganglion (DRG) Stimulation, Stimwave (A wireless SCS system) are few of them. They are not available in India as of now. These advances are good for difficult to treat complex neuropathic pain conditions which cannot be treated by conventional SCS. They are also better as the paresthesia is not felt at all in some of the systems.
Cost and Status of SCS in India
SCS is very much available and being offered to the needy at Pain Clinic Of India. The cost is one of the major factor considered by the patients. In numerous studies it has been shown to be little costly in short term but is very much cost effective in the long term usage. The usual battery life for non chargeable system is 5-6 years and of rechargeable systems is up to 8-10years depending on the daily use. Average cost in India (for Indian patients) is approximately INR 90,000 for trial phase and INR 500,000 for permanent implantation.
The benefits for patients outweigh the cost. It is highly recommended for the patients to go for trial phase and then decide about permanent implantation.
