Spinal Cord Stimulation for the Treatment of Cancer Pain

Cancer pain is often difficult to treat. For many people, medications and injection interventions do not help. When a person has serious intractable pain, one option for therapy is a spinal cord stimulator. Cancer pain places a heavy burden on society and is associated with high expenditures. Severe pain causes a decrease in quality of life for the patient, and when untreated or under-treated, the discomfort can interfere with normal activities. SCS is a proven safe and effective measure for controlling cancer-related pain.

What is spinal cord stimulation (SCS)?

Also called neurostimulation, SCS involves the use of an implantable pulse generator that delivers gentle electrical impulses to the spinal cord. These impulses interfere with pain signal transmission, resulting in replacement of pain with pleasant tingling sensations.

How do I prepare for the spinal cord stimulator implant procedure?

Before the procedure, you will have a trial run with an external device. The wires that run from the device connect to leads that are placed near the spinal cord. The doctor will insert the leads during a simple office procedure. Because mild sedation is used for both the trial and the permanent stimulator implant procedure, be sure to have someone to drive you home. When you arrive at the surgical center, a nurse goes over the risks and benefits of the procedure, and asks you to sign a consent form.

What can I expect during the spinal cord stimulator procedure?

You will be placed face-down on your stomach, and the back is prepped and shaved. The anesthesiologist administers sedation, and a local anesthetic is used to numb the skin over the lower abdomen or buttock, as well as over the spine. The incision is made to place the leads into the epidural space around the spinal cord. Wires are threaded under the skin, which connect to the stimulator device. This half-dollar sized unit is placed below the skin, and the incisions are closed using sutures. The doctor will wake you up during the procedure to see if the neurostimlator is working correctly. The procedure takes around 1-3 hours.

Is the SCS procedure safe?

As with any minimally invasive procedure, there are some risks associated with the spinal cord stimulator implant procedure. While rare, these include bleeding, soreness, bruising, and infection. Most patients do not experience any side effects to the sedation, but dry mouth and drowsiness is to be expected.

What can I expect during the first few weeks following the procedure?

The total recovery time after the stimulator implant procedure is around 4-6 weeks. You will experience some soreness at the site of the incisions. You must keep these areas clean and dry. We recommend you rest for a few days, and gradually return to usual activities. Because your cancer pain will be greatly reduced, you will need to make adjustments to your medication usage.

Does spinal cord stimulator effectively treat cancer pain?

In a systematic review of several studies where spinal cord stimulation was used to treat cancer pain, researchers found that it worked better than conventional measures. In all of the clinical trials, the visual analogue pain scale was used to evaluate effectiveness. Researchers found that spinal cord stimulation was 76% effective, with most patients reporting pain relief at the end of the follow-up period. Scores were reduced by several points with the use of a spinal cord stimulator.

Resources

Lihua P, Su M, Zejun Z, et al. (2013). Spinal cord stimulation for cancer-related pain in adults. Cochrane Database System Review, 28(2), CD009389.

Yakovlev AE & Ellias Y (2008). Spinal Cord Stimulation as a Treatment Option for Intractable Neuropathic Cancer Pain. Clin Med Res, 6(3), 103-106.