When the body’s normal response to an injury is longer than it should, chronic pain develops. The pain has now become harmful and does not protect the body from injury. Chronic pain can affect daily life as there may be issues eating, working out, going to work, and more. Chronic pain can continually deplete a person leading to other health issues including gaining weight or depression, or overuse of medication.
The body is always transmitting signals to the brain. This can lead to injury prevention as the signals may make someone aware if something is not normal. Damaged nerves can send pain signals to the brain even at times when there is no injury. Spinal cord stimulation works to interfere with these signals being sent to the brain so that they are not received.
CAUSES
There are multiple causes for chronic pain. Almost any nerve injury can become a chronic issue. Pain may differ based on the location of the injured nerve. Certain medical conditions, medications, or trauma can lead to a nerve injury. Chronic pain can be caused by a compressed nerve in the back, uncontrolled diabetes, or medical procedures. Mental health can be a factor in one’s ability to manage and feel pain.
A person may also experience periods of constant acute pain because of injury to joints or muscle, arthritis, and other medical conditions. Chronic pain is continuous pain even when an injury or the cause is no longer there. Spinal cord stimulation is helpful in treating chronic pain due to nerve injury.
SYMPTOMS
Symptoms will vary depending on the individual’s condition. Chronic nerve pain can feel like a sharp and shooting pain, throbbing pain, or burning pain. Chronic nerve pain is ongoing and a soft touch or rub may hurt even though it should not. This can cause fatigue, low energy, sleeping issues, or depression. Normal activities may be more difficult to engage in.
WHEN AND HOW TO SEEK CARE
Pain can greatly affect one’s health. If pain interferes with daily activities and does not improve with rest, medical care should be seeked. For an initial evaluation, it is recommended to go to a primary care provider. If pain is ongoing for over 6 months, a pain specialist or may be needed.
TESTING AND DIAGNOSIS
While the cause of some pain can be easily identified, others are not. To come to a diagnosis, a history of the pain and a physical exam may be needed. Imaging and testing can also help to find the cause of pain. To treat chronic pain, it is important to locate the cause of the pain.
TREATMENT
An efficient treatment plan is best made once the patient understands the where and why of their pain. The pain may be spread out or located in one area. There are multiple treatment plans and will vary patient by patient.
Nonsurgical treatments
Nonsurgical treatment is typically the first plan of treatment. Some lifestyle habits that promote recovery is weight management, being active, a stable mental health, eating healthy, and getting proper sleep. Living with chronic pain, these lifestyle habits may be difficult to do. Physical therapy is often recommended. Anti-inflammatory medicine like ibuprofen are the first option to decrease pain. Prescription medications like opioids such as oxycodone might be used to manage pain. These medicines, though, are better for acute pain and not chronic pain. These pain medicines can cause addiction or abuse and should be taken with caution. A medical provider will best advise you on what medication to take.
Surgery
There are multiple surgical procedures to manage chronic pain. These procedures can help identify the root cause and location of the pain and others can help with pain management. Nerve blocks and injection are often used during this process as well as numbing medications or steroid medications to reduce inflammation to a specific area. Pain specialists use this option for pain management without needing a large surgery.
Surgery can be done when a problem appears on a scan or imaging. In neurosurgery, this may include removing bones from the spine or spinal fusions. If a patient's pain has no explanation, then surgery is not the best option.
Spinal cord stimulation (SCS) is a newer technology used to control chronic pain when the injury cannot be repaired. The SCS consists of a device of electrodes connected to a generator. The stimulating electrode will be placed over the spinal cord and block pain signals to the brain. If non-surgical treatments have no proven helpful, a spinal cord stimulator may be a good option. To understand the device and how to manage it, patients will often go through mental health testing. A trial will be done by putting multiple wires in the space outside the spinal cord and controlling them from the unit outside of the patient. This is left in place for around a week to test the effects of the SCS. The patient will not feel the mild electrical pulses created by the simulator. The electrical pulses will block pain signals and also can be adjusted. If a patient feels half of their pain relieved during the trial, it is considered a success. If the trial is a success, there can be a surgery to have a permanent stimulator. Typically the surgery will be done with a small cut in the back and a small cut near the waist. A flat electrode (wire) will be placed through the incision on the back to the space behind the spinal cord. The wire is moved under the skin to the waist. At the waist incision, the wire will be connected to a small battery powered generator. The generator will rest under the skin at the waist. The system is then tested and then the surgeon will close the incisions. The SCS is controlled with a hand remote to make adjustments as needed. Depending on the generator, the battery may need to be recharged on occasion and some will never need to be charged. The generators that do not need to be charged typically are replaced every couple of years. The SCS with rechargeable batteries can last up to 10 to 15 years.
FOLLOW UP
The surgeon will check in with the patient a month after the surgery. The device can be managed by a pain specialist. The only future surgical intervention will be if the battery will be removed or replaced.
