Pain Management Procedures
Spinal Cord Stimulation
Spinal Cord Stimulation - Trial and Implant
What is spinal cord stimulation?
Spinal cord stimulation, or SCS, uses thin leads placed in the epidural space to deliver mild electrical signals that change how pain messages are processed. The leads connect to a small generator. SCS does not remove the underlying condition; the goal is meaningful reduction in chronic pain and improved function.
Who may be considered?
SCS is usually a later option for chronic, difficult-to-treat neuropathic pain after reasonable nonsurgical treatments have not provided enough relief. Depending on the device and diagnosis, it may be considered for persistent neck, arm, back, or leg pain; pain after spine surgery; CRPS; or painful diabetic neuropathy. Careful physical and psychological screening, realistic goals, and insurance authorization are standard parts of selection.
What happens during the trial?
Temporary leads are guided into the epidural space through needles and connected to a generator worn outside the body. The trial usually lasts several days. You track pain, activity, sleep, and medication use. The leads and dressing must stay dry, and bending, lifting, and twisting are restricted. A successful trial commonly means meaningful pain reduction - often around 50 percent - plus functional improvement, but the decision is individualized.
What happens with a permanent implant?
If the trial is successful, permanent leads and a battery are implanted under the skin in a hospital or ambulatory surgery setting. The system is programmed and adjusted over follow-up visits. Recovery includes temporary restrictions to reduce the chance that leads move before scar tissue stabilizes them.
Important risks and practical details
Risks include infection, bleeding, spinal-fluid leak, nerve injury, lead movement or breakage, uncomfortable stimulation, battery or device problems, and loss of benefit. Some systems are rechargeable and some are not. MRI compatibility, driving rules, airport screening, charging, activity limits, and future procedures should be discussed before implantation.
Preparing for your injection procedure…
Your instructions will depend on the procedure. Before any injection, tell the APG team if you:
Take aspirin, warfarin, clopidogrel, apixaban, rivaroxaban, or another medicine or supplement that affects bleeding. Never stop a prescribed blood thinner unless the clinician who manages it and the procedure team tell you how to do so safely.
Have diabetes, glaucoma, a bleeding disorder, an active infection, fever, or recent antibiotic treatment.
Could be pregnant, have an allergy to contrast dye or local anesthetic, or have reacted to steroid injections before.
Use an implanted pacemaker, defibrillator, spinal cord stimulator, or other electrical device.
Some procedures require fasting, a medication adjustment, or a responsible adult to drive you home, especially when sedation is planned. Follow the instructions provided for your specific appointment.
After your injection procedure…
Most injections are outpatient procedures. Mild soreness, bruising, temporary numbness, or a brief increase in the usual pain can occur. Follow the activity and bandage instructions you receive. Steroid medicine may take several days to have an effect and can temporarily raise blood sugar.
Call the office promptly for increasing redness, drainage, fever, severe or rapidly worsening pain, or new numbness or weakness. Seek emergency care for trouble breathing, chest pain, sudden loss of bladder or bowel control, a severe new headache, loss of vision, stroke-like symptoms, or rapidly progressing weakness.
This information is for general education and does not replace medical advice, diagnosis, or treatment. Not every procedure is appropriate for every patient, and results vary. Your APG care team will review your symptoms, examination, imaging, medical history, medications, and prior treatment before recommending a plan. Coverage requirements also vary by insurance plan.