Turning down pain signals in people desperate for relief

Sylvester Walker struggled with an increasing amount of back pain from the severe stenosis that compressed his spinal cord for years. His condition sometimes turned what should have been high points into low ones.

“I was really embarrassed one time. My son plays college ball. I went out there to see him play ball, and man, I had to have people take me out of the stadium because I couldn't climb the stairs. That was just really bad for me.”

Walker’s social life fizzled out, too, as his pain increased while his mobility decreased. “I was afraid to be around people, to have them see me the way I was. I would've probably started crying around them.”

And he eventually lost his job at a Mercedes-Benz plant. “They stuck with me as long as they could.”

 

Finally, Walker, who lives in Moncks Corner, South Carolina, had a life-changing conversation with Martin Burke, M.D., at MUSC Health. “It got to the point where I was just like, man, I'm just willing to try anything right now,” Walker said.

Anything turned out to be a spinal cord stimulation device designed to ease pain. But Burke, who’s board certified in anesthesiology and pain management and an assistant professor at the Medical University of South Carolina, said spinal cord stimulation is not the first thing his team tries in people in chronic pain. 

“For a lot of conditions that cause back pain, we really want to try conservative treatment because a large percentage of them will get better with physical therapy or with low-dose medications from a bunch of different categories we could pick from. But some don't.”

Walker hoped he’d qualify for the stimulation device. But first, he had to undergo analysis, Burke said. “Before we do a spinal cord stimulator trial, they go through a workup period where we get imaging of their back to make sure that there's no contraindication, there's enough room for us to place these wires.”

Then, if all goes as planned, patients get a test run to see if the device works for them. Burke described the process. “We bring them in, give them some sedation, clean off their back like any other surgical procedure. Then, an X-ray camera lines up a specific place in their back. And we use the camera to guide usually two needles into their epidural space in their back. And through that needle goes a wire, and that wire goes to a particular place above their spine, depending on the condition we're treating. We put two wires in.”

 

The system, which includes a battery pack called a generator and a remote control, sends electrical signals to the spinal cord. The spinal cord stimulator signals interrupt pain signals before they reach the brain, resulting in decreased pain. The trial device typically stays in for a five- to seven-day trial. 

Device makers work with the patients during that week. “There are various companies that we use. Often it's Medtronic*, but there are several others. The representative from the company is talking with that patient every day during the trial to adjust the settings based on what symptoms are getting better and what symptoms aren't,” Burke said.

At the end of the trial, the patient returns to the doctor’s office. “We take the wires out, which is like taking a Band-Aid off. And we have a conversation. ‘Did this help you out enough that we are going to get you scheduled for a permanent implant?’” Burke said.

For someone to qualify for a permanent implant, the doctor wants to see at least a 50% reduction in pain. “But pain is only one metric. Another important one is function. Are they able to walk around the neighborhood more? Are they able to get around their house more? Can they go to their mailbox? We establish those goals before we do the trial. We see if they got that relief. And if they did, then the next procedure would be to schedule a permanent implant.”

Walker saw immediate improvement. “When I did the trial, I was able to walk to the corner, and I was like, ‘Oh, wow. That was a big change.’ It was like a light came on in my head. I was like, ‘OK, I'm able to walk to the corner.’ Dr. Burke told me to try to walk further every time.”

Walker did. Once he got the permanent implant, he was quickly able to increase his walks to a mile. “It's amazing, man. I'm able to go back to work. I'm able to get back out, be more sociable again with people.”

Burke said there are several categories of people, such as Walker, who may qualify for spine stimulation, including but not limited to:

• Those who have had back surgery but are still in pain.
• People with complex regional pain syndrome, a condition that causes debilitating nerve pain.
• Patients with persistent diabetic nerve pain.
• People who have chronic back pain but aren’t eligible for back surgery.

“I'm not saying everybody in the country needs a stimulator, but for patients who are so debilitated by pain that they can't wear sheets at night because the sheets brushing their skin feel like fire, there is a treatment option,” Burke said.

“They've done everything else, and they're still functionally limited, incapacitated, can't work, can't do what they want to do.”

*MUSC has a five-year strategic partnership with Medtronic, a medical device company. The collaboration focuses on working together on solutions that improve patients’ health and experiences for patients while lowering costs.