WHAT TO EXPECT FROM A SCS TRIAL
To be considered a good candidate for spinal cord stimulation (SCS) implant, a trial run is usually scheduled. This involves the insertion of thin wires with electrodes attached. The wires are aligned with the affected nerve and attached to an external battery. These are then programmed for the most effective stimulation and reduction in pain response.
The trial period is treated like a long-term pain therapy. The difference is that the device transmitting current is not implanted in the body. Just the wires are inserted. An external transmitter sends electrical pulses to the electrical contacts near the spinal cord.
During the 5 to 7-day trial, the patient is asked to note the level of pain relief in different situations during the day and night.
The trial period procedure is usually performed in a pain management physician’s office or a surgical center. Procedures do vary, depending upon the stimulation device used, but these are the typical steps:
Local anesthesia is applied to the injection site. Sedation may be provided.
Guided by fluoroscopy (a type of X-ray), your doctor inserts a hollow needle into the area around the spinal canal (referred to as the epidural space). The needle holds thin, insulated wires, called leads with electrical contacts attached. In select situations, a small incision might be needed to insert the needle.
The doctor then wakes up the patient in order to get is feedback on specific areas of pain relieved by stimulation as well as where pain relief may still be required. And, if a low-frequency system is used, the goal is to cover all painful areas with a slight tingling sensation known as paresthesia. However, devices implementing newer technologies generally avoid the tingling sensation and do not always require a wake-up test, as each electrode affects pain in a different area. No matter the device selected, doctor-patient communication is crucial in making sure the location of the electrical contacts covers all areas of pain. Once a patient has reported on pain-relief, they are again sedated.
The leads are then connected to an attached, external transmitter that is given to the patient to control. The wire connected to this external neurostimulator is taped to the person’s back during the trial to hold it in place.
After the procedure the patient is given time to recover before going home.
A hand-held controller is programmed by the doctor and a specialist to adjust the amount of stimulation based on the procedural feedback.
The patient is given control of the remote and can operate it as needed to send pulses of current as needed. It provides the ability to adjust the intensity and duration of stimulation.
Usually your doctor will ask the patient to track which settings are used at which times and how well the pain is relieved. If pain is not being relieved, the doctor should be notified. In some cases, the device can be reprogrammed. However, if relief ceases, the trial may be concluded as unsuccessful.
The site on the back where the leads and electrodes are inserted is often uncomfortable for a few days. But any significant local pain should be reported to the doctor.