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Leading Medicine Magazine, Vol 7, No 1 - 2013

is transformed into a more pleasant tingling sensation “because that gate in the spinal cord has been closed.” The spinal cord stimulator delivers tiny pulses of electricity to the spinal cord through implanted leads in the patient’s back. These leads connect to a small generating device — also implanted — that is in turn controlled through a small wireless remote control. Although the theory behind these stimulators had been around since the 1960s, spinal cord stimulators did not become popular until the 1980s when European physicians used them not only for back pain, but also for treatment of angina. In the United States, the Food and Drug Administration has only approved spinal cord stimulation for chronic pain, although Satija says studies continue to explore its use for heart patients. EFFECTIVE PAIN RELIEF FOR COMPLEX CASES Spinal cord stimulation has come into use as a way to ease types of pain that have eluded relief from more typical treatments. “What we have learned over the last few years is that there are some very important ways to ease chronic pain which have not responded to multiple surgeries and pain medications,” Satija says. “Most times, patients have had medication, physical therapy and maybe traditional surgery,” says Dr. Richard K. Simpson Jr., a neurosurgeon with the Methodist Neurological Institute. “If one of those things fails,” he continues, “then spinal cord stimulation is something to consider.” There aren’t narrowly defi ned parameters to identify patients who are suitable for spinal cord stimulation. “Spinal cord stimulation is not for everybody,” Satija says. “It is about choosing the right patients and giving them this option at the right time in their treatment plan. It has to be decided on a very individualized basis.” To this end, before Satija approves patients for spinal cord stimulators, he completes a series of tests to decide candidacy. For instance, young patients with classic neuropathic pain, who have had one small surgery and a few problems, may not be candidates. Satija says a typical patient is older, has had surgeries that have not relieved the pain and, in some cases, may no longer be able to tolerate medication. That said, the nature of spinal cord stimulation can be effective for patients with a wide range of conditions. “This is not as invasive as spine surgery; it does not give you the bad side effects of medications, and it does not require the patient to be proactive, such as doing physical therapy,” says Satija. “It is not a treatment restricted by your body type. Big people can have it; small people can have it; young people can have it; old people can have it.” A TRIAL PERIOD — THEN A MINOR PROCEDURE Before implantation surgery, patients have an opportunity to “test drive” the device. In this trial period, doctors place electrical leads over the spinal cord. The leads hang outside the skin, connected to a small battery that the patient carries in a fanny pack or pocket. The patient returns home and wears the temporary device for a week to 15 days to see if it works. “The patients get to decide whether this is something they absolutely love or is life-changing for them,” Satija says. “When I put this instrument in someone I want to know, number one, is their pain signifi cantly better? I tell them, ‘Your pain should be 80 or 90 percent better or this is not the instrument for you.’” Satija says that during this trial period, he wants his patients active and wants them off pain medication. “Once these criteria are met, I will give them the go-ahead to get the stimulator.” Surgical implantation of a spinal cord stimulator can take as little as an hour to perform, and the procedure is completely reversible. “If the patient decides he doesn’t want it, the mechanism can be removed,” Satija explains. Simpson says he occasionally has removed a stimulator when the patient doesn’t feel it’s needed any longer. “We do have patients that this stimulator gets them through a window of pain that lasts for a few years and, down the road, they fi nd they are not using it as much,” he says. “Some patients ask to have it removed, but that isn't common.” HIGH HOPES FOR A TOUGH COOKIE Redman says she cannot wait to get her permanent stimulator. At this writing, she is in her trial period with the new device, and is thrilled with the experience. “Within 30 minutes of getting the device, I didn’t have pain,” she says. “The next day, I went out to the grocery store and could push the cart without being all bent over.” She is also optimistic about a return to the dance fl oor. “I love dancing. Right now, if I do socialize, I just sit there, wishing I could be out there on the dance fl oor. I always used to be the fi rst to liven up the party, but right now it is just sitting and watching.” Redman is confi dent that this wallfl ower phase will be a temporary one. “It’s going to be a good future. I have hope now. Once out of the pain, I am okay.” n To learn more or to fi nd a specialist, visit methodistneuroinstitute.com or call 713-790-3333. Leading Medicine • Volume 7, Number 1 4 7


Leading Medicine Magazine, Vol 7, No 1 - 2013
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