Considering the significant concerns around use of narcotics for pain management, finding an alternative for back pain — especially for chronic pain — is always a welcome development. With spinal cord stimulation, that promise comes with plenty of history.
“This is a technology that's been in use since the 1960s, with FDA approval since the early 90s, so we've had time to understand it as the technology gets refined,” says Soriaya Motivala, MD, neurosurgery specialist at Northwell Health in New York. “It's now in the realm of personalized medicine. There are quite a lot of exciting applications that we're seeing now and likely to see in the future.”
Traditionally, spinal cord stimulation was used for failed back surgery syndrome — a misleading term, since it is not a syndrome, but rather a descriptor for pain that persists despite surgical intervention. The treatment has been studied in recent years for broader use; for example, a study from the University of Washington that it may improve hand and arm function in people with spinal cord injury.¹
The stimulators have also been used for complex regional pain syndrome, according to Dr. Motivala, but some patients didn't like the feeling of buzzing that came as a result of the electrical current. She explains that was resolved when a high-frequency stimulator was introduced that eliminated the tingling sensation.
“Those kind of shifts, which might seem minor, really open up this treatment to a wider population,” says Dr. Motivala. “Newer developments in just the past couple years are making this a very exciting option.”
New Uses
One of those changes has been an implantable stimulator device that can be used with an MRI, Dr. Motivala says. Previously, this wasn't possible, which made imaging more limited for these patients.
Considering the prevalence of MRI scans for this patient population, that represented a considerable problem.Research in the journal Spine found that up to 84 percent of patients with a spinal cord stimulation implant were expected to need at least one MRI within five years of implant.²
“It was a burden to have a device that was not MRI-compatible because if a patient's back pain was worsening, you had fewer tools to see what was going on,” she says. “You would also be less able to detect cancer. This is a real game changer for the technology.”
Another recent shift has been FDA approval of the technology specifically for diabetic neuropathy, according to Vernon Williams, MD, neurologist, pain management specialist, and founding director of the Center for Sports Neurology and Pain Medicine at Cedars-Sinai Kerlan-Jobe Institute in Los Angeles.
“That condition has been difficult to treat, and medications can have many side effects with marginal benefits,” Dr. Williams says. “This treatment applied to diabetic neuropathy will help a lot of people because there aren't any other good options right now.”
Using the treatment for patients with chronic back pain is an another growing trend, he adds. That is because the stimulation tends to offer considerable improvement while being minimally invasive.
“The horizon is really bright for this, because it can be applied in various circumstances,” he says. “You have traumatic injury and chronic pain as well as nerve pain, and spinal cord stimulation may be an option for a breadth of patients with these issues.”
Long-Term Outlook
In terms of what is on the horizon for spinal cord stimulation, one feature that's imminent is cloud-based connectivity, Dr. Motivala says. That means a doctor will be not only able to see data that is transmitted from the device and accurately gauge activity and sleep, but also deliver adjustments virtually.
“COVID hastened telehealth, and now we're harnessing that in a major way,” she says. “This could be part of that, where your specialist can do a virtual visit and tweak the way the stimulation is delivered, without a patient having to leave their home. That has huge potential for removing some of the burden on patients for care.”
The potential for this shift has been highlighted during the COVID-19 restrictions, according to commentary in Frontiers in Neuroscience.³ However, those researchers note that there are some barriers to overcome, such as the novelty of the new system, difficulty for adoption by elderly people, and potential communication issues between doctor and patient.
It is also possible that spinal cord stimulation would be more prominent in reducing surgery prevalence, she adds. That is crucial for patients who are hesitant to get surgery and want another option, but also for those who are not candidates for a more invasive procedure. For example, Dr. Motivala says, an 82-year-old with severe scoliosis and cardiovascular issues would obviously not be recommended for surgery, but spinal cord stimulation could provide relief.
“This is likely to become a more front-line therapy going forward,” she notes. “Research already suggests that when using a stimulator, narcotic use declines substantially, so this could be an important option for patients going forward.”