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What is spinal cord stimulation?
Spinal cord stimulation for CRPS and other chronic pain conditions is a form of ‘neuromodulation’, i.e. technology that acts directly upon nerves. A spinal cord stimulator (SCS) is a small pacemaker-like, remote-controlled battery pack implanted under your skin (usually in your hip or abdomen). The electrodes connected to this device are placed in the epidural space. This allows the delivery of a low-level electric current to your spinal cord. The surgeon places the electrodes at the spine level appropriate for your symptoms, intending to interrupt pain signals before they reach your central nervous system.
With traditional SCS, the hope is that you feel a light-tingling sensation called ‘paraesthesia’ instead of pain over the affected area. However, some people find this sensation unpleasant, so newer SCS devices offer ‘sub-perception stimulation’ where the paraesthesia is imperceptible.
Spinal cord stimulation for CRPS
As with many medical procedures, spinal cord stimulation offers no guarantee of success. Some CRPS sufferers say SCS has proved a life-changer; others wish they had never undergone the procedure. And many people between those two extremes experience some benefit, but perhaps not what they had initially hoped. Among the worst cases of SCS I have encountered are those where people believe the implantation procedure caused their CRPS to spread.
Another risk associated with SCS is infection, which can be very serious given the proximity to the spinal cord. Recently, I had a client whose SCS provided extremely positive results but which, very sadly, had to be removed a few weeks following implantation due to infection.
Dorsal root ganglion stimulation for CRPS
Dorsal root ganglion (DRG) stimulation is a newer, more targeted form of neuromodulation, broadly similar to SCS.
The DRG is a small bundle of nerves branching from the spinal cord. It acts like a traffic light, controlling when nerve signals enter your spinal cord to travel to your brain. Evidence suggests that the DRG may cause hyperexcitability in the central nervous system, leading to some of the symptoms most associated with CRPS, including allodynia and central sensitisation.
In SCS, the electrodes are placed in the epidural space behind the spinal cord, i.e. further from the nerves. However, the DRG is much more accessible, meaning placing the leads much closer to the target nerves is possible. The device can then better focus on stimulating the areas where you feel pain.
Can I recover the cost of SCS or DRG stimulation in my compensation claim?
Although SCS and DRG stimulation are available on the NHS, you will unlikely be offered either until other less invasive therapies are exhausted. Once referred, current NHS waiting lists are lengthy.
Privately, both procedures are very expensive and involve ongoing specialist management. And remember, there’s no guarantee of success. Even in cases where pain is reduced, the benefit can lessen over time.
However, pushing negativity aside, for some of my clients, SCS or DRG stimulation has proved transformational.
Potentially, the cost is recoverable in the context of your compensation claim. Your pain medicine expert in the claim must agree that, on the balance of probabilities, the procedure is likely to be of benefit. Also, your treating pain consultant needs to refer you. And whether your procedure is private or NHS, you must undergo both a physical and psychological suitability assessment.
Perhaps the biggest practical problem is securing funding. It’s rare for the defendant’s insurer to volunteer significant interim payments for treatment and rehabilitation. Consequently, in many cases, it’s first necessary for me to apply to the court for an order for an interim payment. Interestingly, on making such an application, funds are often then volunteered before a hearing is necessary!
It’s also worth mentioning that the insurer does not escape responsibility for payment if you proceed on the NHS. The NHS can recover their outlay for accident-related treatment from the defendant’s insurer. Indeed, for that reason, the insurance company is legally obliged to report your claim to the NHS at the outset.