A pain doctor's comments on Spinal Chord Stimulators

Patients: I make sure I have the correct diagnosis

Infection: I prophylax every patient, continue for two weeks after implantation, and I don't do the procedure if a suggestion of even a remote illness has occurred. I also don't perform the procedure in a cesspool. I give the antibiotics that cover the local hospital organisms.

Placement: If I am putting the device in the cervical spine, I place it, with the patient awake, "troll" the lead until the patient identifies the effectiveness, (usually at C-5) and I trial it for a week to let the patient tell me if it works.

Unusual stim: I have my neurosurgery partners put a permanent laminotomy lead in so it doesn't migrate and cause unusual patterns of stim or become dislodged, or migrate with the patient movement. If the stim varies a little bit I reprogram the lead with a computer until I eliminate the effects the patient doesn't want and we get the coverage we expect.

Heartbeat and respiration: C-3-4-5 yes can control the diaphragm. I am adjacent to the midline of the dorsal spine, not near the anterior branch of the above nerve roots. Yes the Heartbeat is primarily a sympathetic function and again the Stellate Ganglion and the T2-T3 ganglion are distant. If I saw unusual patterns of control it would most likely reflect a de-enervation syndrome that might prevent the patient from having the autonomic cardio acceleration (much like a heart transplant patient)or a patient that has an ablative sympathectomy. The device is not a pacemaker with a rhythmic pulse that can override the cardiac muscles intrinsic ability to generate a heartbeat.

Again, see a qualified doctor, get on the net, complain to the manufacturer so he can clarify some things to you. You will find nothing but helpful informative people that will be OVERLY concerned if any of the things you say are related to this very valuable technology.

Jim - A doctor in a California Pain Center

Postscript from Further correspondence with Jim

My experience has been good to date. I screen all patients for borderline personality traits, and utilise all that is available from meds to behavioural medicine. The last thing I want is someone convincing me to put in an implantable and not even go to Physical Therapy.

I will point out the some studies like the University of Utah show very poor plus/minus benefit of stims in RSD for the period after a few months.

Most of us realise that patients have to be motivated. It is the PT and the range of motion restoration, and the development of aerobic tolerance that will actually heal them. Things like a Stim are simply the facilitating device. It doesn't mean that the patient will never take another pill, or see other parts of their body affected later.

Keep up the information dissemination. knowledge is the best whether one is buying a car or having surgery.