Recent clinical studies have shown significant improvements in pain with spinal cord stimulation for chronic pelvic pain.
How many people have SCS?
Around the world, 34,000 people undergo a spinal cord stimulator (SCS) implant surgery every year. The device was first used in 1967 to treat pain. A SCS delivers mild electrical stimulation to nerves along the spinal cord, and the current modifies nerve activity to decrease the sensation.
How common is chronic pelvic pain?
According to clinical studies, chronic pelvic pain is a common problem, affecting 1 in 7 women. A recent study found that of women of reproductive age, the prevalence rate of pelvic pain was 40%, and 10% of gynecologist referrals are related to pelvic pain.
Does spinal cord stimulation work?
In a recent clinical study, SCS was evaluated in patients with chronic, long-standing pelvic pain related to endometriosis and dysparenunia. All patients underwent SCS trial for 7-14 days, with permanent implant surgery following. On 2 to 3-year follow-up, median visual analog scale pain scores decreased by 5 points (from 8 to 3). All patients reported more than 50% pain relief. The researchers concluded that SCS had significant therapeutic potential for treating visceral pelvic pain.
How does spinal cord stimulation work?
Stimulation with SCS reduces abnormal pain signals that reach the brain. In addition, it restores the normal pain-inhibition pathways that may have been previously diminished or lost. SCS does this by eliciting the body’s chemical neurotransmitters that nerves used to communicate with one another.
When is SCS considered?
The pain management specialist will not usually recommend spinal cord stimulator implant surgery unless the patient has had chronic pain for more than 12 months. In addition, the pain must have been poorly controlled with other measures, such as physical therapy, injections, and medications.
What can I expect to happen first?
Spinal cord stimulation starts with a trial phase. The doctor will guide a hollow needle into the epidural space, which surrounds the spinal cord. This is done using real-time x-ray, so the doctor can assure correct needle placement. Through the needle, the doctor will thread tiny leads, which have small electrical contacts along the end.
These leads are attached to a power supply (outside the body) that delivers a mild current. The doctor will ask for feedback from the patient regarding the sensation of the electrical current. The external device is worn for 7-14 days, so the doctor can assess pain control.
When will the actual surgery take place?
A response is usually considered adequate if the patient reports pain reduction of at least 50%, but improvement of activity and function are also considered. Once the pain specialist approves the trial as effective, the implant surgery is scheduled.
What can I expect with the SCS procedure?
You will be scheduled at the medical facility to have the minor surgery. The surgeon will implant the power device (called a generator) in the lower abdomen or upper buttock region. The device is about the size of a man’s watch face. Wires run from the battery-powered unit to the implanted leads along the spine. The procedure involves tiny incisions, that are closed with sutures.
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Kapural L, Narouze SN, Janicki TI, & Mekhail N (2006). Spinal cord stimulation is an effective treatment for the chronic intractable visceral pelvic pain. Pain Medicine, 7(5), 440-443.
Zondervan KT, Yudkin PL, Vessey MP, et al. Prevalence and incidence of chronic pelvic pain in primary care: evidence from a national general practice database. Br J Obstet Gynaecol. 1999 Nov. 106(11):1149-55.