Spinal Cord Stimulator Implant (Neuromodulation) for Phantom Limb Pain

Phantom limb pain (PLP) is any pain perceived by the body region that is no longer present. This condition is poorly understood and difficult to treat. Experts now recommend the use of spinal cord stimulation (SCS) for the treatment of phantom limb pain.

How common is phantom limb pain?

In the U.S. a recent study found that 1.6 million people lived with an amputation. Of these people, the incidence of PLP is 42-78%, depending on the source. Common causes of limb loss include vascular problems, cancer, trauma, and congenital limb deficiency.

What is a spinal cord stimulator implant?

A spinal cord stimulator implant is a small device that is surgically placed in the body. The generator has a tiny battery, and this unit delivers mild electrical current up wires that run to the spinal column, which attach to tiny leads. Many studies show that SCS is effective for treating pain related to the extremities.

How does spinal cord stimulation work?

The spinal cord has many tracts of nerves that communicate information between the brain and the rest of the human body. Spinal cord stimulation involves interference with pain signal transmission. Spinal cord stimulators are similar to pacemakers, designed to generate mild electrical impulses. Stimulation of a specific nerve tract along the spinal cord will interfere with the conduction of pain to the brain from the lower extremities.

What is a trial?

Before permanent implantation of the spinal cord stimulator, a trial run is performed. During the procedure, the doctor inserts tiny leads through a special needle. These electrodes are connected to the batter source, which is outside the body. The patient will wear this for 5-7 days to see if it helps pain.

How is permanent implantation done?

The spinal cord stimulator procedure is performed using general anesthesia. An incision is made over the spine, and fluoroscopy (real-time x-ray) is used to place the electrodes along the spine. Once in place, the surgeon runs wires under the skin to the buttock region or lower abdomen. An incision is made so the generator can be placed under the skin and over the muscle tissue. The wires are attached to the tiny device, the incisions are closed, and a dry bandage is applied.

What can I expect after the spinal cord stimulator implant procedure?

After the procedure, you cannot drive for 4 weeks. Expect some soreness at the incision site, as well as mild bruising and scant bleeding. You are not allowed to participate in any rigorous activities for several weeks, should avoid sexual intercourse and climbing stairs, and must not elevate your arms over your head. You can return to usual activities gradually, but must keep the incisions clean and dry until sutures are removed.

Does spinal cord stimulation work?

Many studies show that SCS neuromodulation for phantom limb pain is a safe, effective procedure, and it is used to improve quality of life for patients suffering with chronic phantom limb pain. In a recent clinical study, the success rate for SCS was found to be around 80%, with the majority of patients reporting excellent pain relief.

Resources

Subedi B & Grossberg GT (2011). Phantom Limb Pain: Mechanisms and Treatment Approaches. Pain Res Treat.

Viswanathan A, Phan PC, & Burton AW (2010). Use of spinal cord stimulation in the treatment of phantom limb pain: case series and review of the literature. Pain Practice, 10(5), 479-484.