Sometimes a patient with back pain has tried everything–pain killers, physical therapy, injections, even surgery-and still has pain. This is where a specialist like Dr. Christopher Winfree from the Neurosurgical Pain Center at Columbia University Medical Center/NewYork-Presbyterian Hospital comes in.
He can surgically implant a spinal nerve root stimulator (SNRS) to block pain signals to the brain. Dr. Winfree spoke to neurosurgeons at a meeting of the World Congress of Neurosurgery about how to do this. He gave an overview of several placement methods and their best use.
An SNRS is similar to a pacemaker. It has a small power unit that attaches to electrodes that deliver electrical impulses. Patients can control their intensity with a remote. When delivered to a nerve, the electrical stimulation can override pain signals. It may help if you think of nerves as telephone wires to and from our brain. If pain is a bill collector on the line, then an SNRS offers a way to turn up the static so you canʼt hear it. These devices can be placed anywhere along a nerveʼs pathway: at the spinal cord, as it exits the spine, as it travels down the arm or leg, or just under the skin.
Placement on the spinal cord is often a surgeonʼs ﬁrst choice to immediately relieve pain in the arms or legs. This technique has a long track record but it has limitations. Pain that is speciﬁc to the low back, hand, foot, groin and buttock can be harder to target with this approach. Also, over time, pain can stop responding to the spinal cord stimulation. For these reasons, surgeons may choose another placement point, initially or supplementally.
Individual nerves become easier to access once they leave the spinal cord. Pain that lies within the pathway of a certain nerve can be relieved by placing an SNRS electrode anywhere along that nerve between the spine and the painful area. A couple of techniques have been developed to target nerves as they exit the spinal cord (see our post A New Way to Give an Old Vet Relief to learn more). Electrodes can also be placed further along the nerve closer to the area of pain. For example, some nerves in the foot can actually be targeted in the back of the knee (see our post Surgeons Use Ultrasound, Not to Find a Baby, but a Nerve to learn more).
Targeting nerves in this way can provide signiﬁcant relief but only when pain falls inside a speciﬁc nerveʼs pathway. When it doesnʼt, SNRS electrodes can be placed under the skin, right where it hurts.
Each method has its best use, and any one may be just what a patient needs. Patients who end up in Dr. Winfree’s office sometimes have much more complicated pain patterns and need a combination of methods. In any case, an SNRS can be a powerful tool that provides long suffering patients with a way to turn up the static when pain calls; in fact, they may not even hear the phone ring.
Originally published Jan 6, 2010
Updated April 18, 2017
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