Neu­rostim­u­la­tion for Chronic Pain (2011)

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Neu­rostim­u­la­tion for Chronic Pain

Infor­ma­tion for patients and families

I. What is neurostimulation?

Neu­rostim­u­la­tion is used to treat long last­ing (chronic) pain. It’s an elec­tric sys­tem that will be placed in your body. The bat­tery will be placed under your skin and the lead (med­ical wire) will be placed either in your spine at the back, at your neck or on a spe­cific nerve. The neu­rostim­u­la­tor works by send­ing mild elec­tri­cal beats to the space near your spine. These elec­tri­cal beats block the pain mes­sage from reach­ing your brain, and replace the pain with another mes­sage of tin­gling.
Because the neu­rostim­u­la­tor works in the area where the pain mes­sages travel, elec­tri­cal beats (which are felt as tin­gling) can be sent to spe­cific parts of your body where you are feel­ing pain.
Neu­rostim­u­la­tion does not remove the source of your pain, but can change your feel­ing of pain. The results can vary from one per­son to another.
Your par­tic­i­pa­tion is impor­tant for the suc­cess of this treatment.

II. Who can ben­e­fit from neurostimulation?

In gen­eral, neu­rostim­u­la­tion is con­sid­ered when other options for the man­age­ment of chronic pain have been tried and have failed. Some of these options are:
• You had at least one surgery on your spine and no more surgery is planned on your spine or the nerve
• You have tried treat­ments like nerve blocks, phys­io­ther­apy and epidu­rals
• Med­ica­tion did not ease your pain enough or the side effects have been too bad
• You have been eval­u­ated by a psy­chol­o­gist for your pain prob­lem
• You can under­stand how neu­rostim­u­la­tion works and what you will need to do
• You do not have a drug habit
• You do not have an infec­tion
• You do not have a pace­maker

When you are referred by your doc­tor to the MNH Chronic Pain Clinic for a neu­rostim­u­la­tor, you will be seen and exam­ined by many mem­bers of the team who will decide if this ther­apy would be right for you. The team will meet after they each have seen you and decide if this ther­apy could be good for you.
If the deci­sion is yes, they will refer you to the Pread­mis­sion clinic to pre­pare you for the surgery. If this is not a good option for you, you will be referred to other clin­ics or options.

Neu­rostim­u­la­tion is used to treat long last­ing pain in these con­di­tions:
• Chronic back pain after surgery and related pain in the legs
• Com­plex regional pain syn­drome (CRPS) or Algo­dy­s­tro­phy
• Nerve pain
• Pain related to refrac­tory angina (pain that is caused by a heart condition)

III. How is it implanted?

The neu­rostim­u­la­tor is implanted at the MNH in 2 phases:
The day you have this surgery you must bring some­one with you. Please bring all your med­ica­tion
with you.

This is a test period.
Phase 1 is to insert the lead (wire) in the epidural space in your spine or on a spe­cific nerve. You will receive local anes­the­sia (an injec­tion to freeze the skin) for this step. After the lead is inserted, the stim­u­la­tion is started by the sur­gi­cal team to be sure that the wire is in the right place. The lead will then be con­nected to an exter­nal bat­tery and you can try the neu­rostim­u­la­tion for 1 or 2 days.
Phase 1 is usu­ally done as a day surgery, you will be able to leave the hos­pi­tal after it is done.
If you live far (more than one hour by car), we advise you to stay in town. We will give you a list of places to stay near the hos­pi­tal if you need it.
Before you leave we will teach you how to use the stim­u­la­tion, how to care for the wounds, and what med­ica­tion to use at home. We will also speak to you about daily activ­i­ties.
The pur­pose of this test is to find out if the neu­rostim­u­la­tion will work on your pain. We will ask you to rate your pain on a 010 scale dur­ing the expe­ri­ence, and to tell us how much the pain has gone down in per­cent­age (i.e. 1050%) once you started using the neu­rostim­u­la­tion. We will also ask you to tell us if you feel tin­gling replac­ing the pain in the painful area and if you think you can do more things like walk­ing and sit­ting while you are on neu­rostim­u­la­tion.
As pain is mostly a per­sonal expe­ri­ence, we need you to tell us if the stim­u­la­tion is help­ing to ease the pain.
If the neu­rostim­u­la­tion does not work for you dur­ing the test period, the lead is removed. If this Phase 1 test has worked to reduce your pain, a com­plete neu­rostim­u­la­tion sys­tem is implanted (Phase 2).

Phase 2
The com­plete neu­rostim­u­la­tion sys­tem will be implanted.
When this is done, you will receive gen­eral anes­the­sia (med­ica­tion that will put you to sleep). In most cases the bat­tery will be implanted in your abdomen or in your chest.
This is also a day surgery and you will be able to leave the hos­pi­tal on the same day. The neu­rostim­u­la­tion will not be started on this day. You will have to come back to the clinic in 1014 days to have it started. Your stitches will be removed in the clinic or by the CLSC if needed.
You are respon­si­ble for the equip­ment, like the patient pro­gram­mer, that we give you after the surgery.
Please bring some­one with you both times you come, for your trial and your final implant.
After the neu­rostim­u­la­tor is implanted, you will be seen at the clinic every month for 3 months and after that as needed.

What are the pos­si­ble com­pli­ca­tions?
Like all surg­eries some prob­lems can hap­pen right after the surgery:
• You may have an infec­tion. This is very rare and an antibi­otic ther­apy will be started.
• The lead might move or get out of place.
• The stim­u­la­tion may not cover the painful area or stop reliev­ing your pain. You will need to have the neu­rostim­u­la­tor reprogrammed.

IV. What you should know about neurostimulation.

• Do not drive a motor vehi­cle or oper­ate heavy machin­ery when the stim­u­la­tor is ON to pre­vent the risk of an acci­dent by a sud­den surge of stim­u­la­tion.
• Talk to your doc­tor before hav­ing your spine manip­u­lated by a chi­ro­prac­tor or osteopath.
• Be care­ful about going through secu­rity sys­tems such as those found in libraries or air­ports. These devices may con­tain a strong mag­net which may turn your stim­u­la­tor ON or OFF.
• The stim­u­la­tion may become stronger when you bend your neck or back or when you lie down or sit. You can reduce the inten­sity with your patient pro­gram­mer.
• The stim­u­la­tion may become weaker when you stand up. You can increase the stim­u­la­tion using your patient pro­gram­mer.
• The stim­u­la­tion may seem to stop when you bend for­ward or back­ward. It will restart again when you change posi­tion.
• If the stim­u­la­tion is uncom­fort­able at any time, turn the stim­u­la­tor off, and con­tact the clinic for an adjust­ment and bat­tery check.

For 8 weeks fol­low­ing surgery for spinal cord stim­u­la­tor, DO NOT :

  • Put your arms over your head
  • Bend, twist, stretch, or lift more than 5 pounds
  • Sleep on your stomach
  • Climb too many stairs
  • Sit too long in a chair
  • Drive for sev­eral weeks or accord­ing to your physician’s instruc­tions. This is to lower the risk of sud­den move­ments or shifts in your posi­tion which will increase the risk of lead movement.


The fol­low­ing med­ical pro­ce­dures and equip­ments are INCOM­PAT­I­BLE with a neu­rostim­u­la­tor, please tell your doc­tor if you have to have one:
  • Mag­netic Res­o­nance Imag­ing (MRI)
  • Radio­ther­apy with X-​rays that deliver more than 700 rads
  • Defib­ril­la­tor
  • Elec­tro­cautery near the stim­u­la­tor (used dur­ing surgery)
  • Diathermy (Heat treatment)
  • Car­diac pace-​maker

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