(This question was raised by Geraldine (USA) and answered by Karen, a member of the RSD Alert Team)

I have been through the temporary stimulator process as well as having the full SCS implanted two weeks after the temporary stimulator operation.

When you have the SCS implanted it's done in two stages: -

• lead implantation procedure (the trial screening)
• complete system implantation procedure.

When I had mine implanted it was done in the Day Unit of the Hospital. You need to be awake during the procedure so you will be given a local anaesthetic in your back. Some Doctors also give a mild sedative at this time as well (although I never had that myself). You have to lie on the theatre table on your stomach but will normally have pillows under your chest and head. But then this also depends on where your leads are going to be placed. As I had my lead implanted into my neck I couldn't have a pillow as otherwise I might have suffocated. I had to keep my head straight throughout the whole procedure.

Once he has given you the local anaesthetic, the surgeon will start the procedure, during which you will feel a bit of tugging, but you shouldn't feel any pain. If by any chance you feel any pain you should just yell out and the surgeon will inject more local anaesthetic.

To insert the lead they use a special needle or a special surgical procedure to insert the lead. There will be an x-ray machine in the theatre so that the surgeon can see exactly where he is placing the lead. Once he feels that it is in the right place they will connect the lead to an external screener. You will probably also have the chronic pain nurse in theatre with you and she will then turn the SCS device on. They will then ask you questions like: -

• where do you feel the tingling sensation?
• is it covering the painful area?
• is it comfortable or does it hurt?
• how much of your pain is being covered by it?

They carry on with this until the surgeon has found the best place to site the lead so that it's comfortable, covers your pain area properly and so that they get the best coverage of the pain for you.

Once this has been done, which can take a while, the nurse will turn off the device and the surgeon will anchor the lead into place. After anchoring the lead so that it can't move they will turn the device back on and re-check with you that it is still in the correct place.
When he is satisfied with the lead placement, the surgeon will tunnel the lead through your shoulder and then close the wounds. The lead will come out of your shoulder at this time and will be connected to the external screener, which you take home with you so that you can play about with the screener to change the stimulation within the ranges they have set for you until you find the best cover for your pain. You will have to keep note of the effects of the stimulation during your trial screening, which could last from a couple of days up to about a week or two.

If you find that the SCS helps a lot with the pain the surgeon will then go ahead and implant the full SCS; but if you find that it doesn't suit you for any reason he will then remove the lead.

Karen Temple (a member of the RSD Alert Team)