August 20, 2018

A Powerful New Non-Opioid Treatment for Chronic Pain

By Victor Tseng, DO

 

While spinal cord stimulation has been available for decades, rapid technological advances during the past year have opened this non-drug therapy to significantly more patients who suffer from chronic intractable back and leg pain. 

One of the most promising developments is a new system that simultaneously combines two frequencies of internal stimulation – one perceptible to patients and one completely unnoticeable – to provide what often is remarkable long-term pain relief – the Spectra WaveWriterTM Spinal Cord Stimulator System.
In my practice, patients have upward of 80 to 90 percent benefit of pain relief from this combination therapy, compared to 50 to 70 percent benefit with more traditional SCS systems. Many of these patients have undergone multiple back surgeries and relied on opioid medications for years, if not decades.

All SCS works by sending low electrical pulses to the spinal cord to interrupt pain signals to the brain. Similar to a pacemaker, systems involve implantation of thin lead wires and a rechargeable battery; wires travel to specific nerves in the spine and the battery is placed just beneath skin in the low back. 

With more traditional technology, known as paresthesia-based or tonic stimulation, patients describe a mild vibrating, pulsing, tingling or buzzing sensation. On the other hand, the new system can perform sub-perception stimulation, also known as “no-feel”, which operates at such a high frequency that patients can’t detect them. I compare it to a wheel that spins so quickly the eyes can no longer perceive motion. 

Each system targets a different area of the spinal cord, thereby activating distinct nerve pathways and brain regions to provide better pain coverage. Tonic stimulation delivers pulses to the dorsal column at the middle to posterior side of the spinal cord, while sub-perception stimulation aims for the dorsal horn, one of the gray longitudinal columns within the spinal cord. We can either pinpoint one specific pain area or use each therapy as needed to manage multiple problem regions. 

Patients vary in which sensation they prefer: some enjoy mild vibratory sensations, while others like the “no-feel” setting. With a combination system, patients can use a handheld remote control to alternate their own settings and stop or start stimulations throughout the day or night. 

The broader audience of potential beneficiaries range from young patients who have suffered a traumatic injury, including some of our military veterans, to older populations who could not tolerate an extensive back surgery. Some people, including my very first patient, have reported near 100 percent improvement. 

Implanted devices can last indefinitely, although they also may be removed at any time. Before implantation – generally an outpatient procedure – patients are able to test SCS during a three- to five-day trial period, using external wires securely taped to their backs. As everyone’s anatomy and pain complaints are different, we also use these trials to determine the ideal placement of internal leads. 

I believe SCS will continue to gain acceptance as a valuable alternative to repeated surgeries and medication, particularly given our country’s current epidemic of opiate addiction. I am committed to educating as many patients as possible about this innovative weapon against life-altering pain.

Dr. Tseng, an Interventional Pain Medicine specialist at Sports Medicine & Orthopaedic Center, is Board certified in both Physical Medicine and Rehabilitation and Pain Medicine. He takes a holistic approach to post-surgical care, injury recovery and pain management, utilizing injections, interventional procedures, physical therapy and advanced treatments such as radiofrequency ablation and kyphoplasty. smoc-pt.com