Back in June 2011, we published an article on our blog regarding a client who had been fitted with a Spinal Cord Stimulator (“SCS”) following a diagnosis of Complex Regional Pain Syndrome Type 1 (“CRPS”) in his left foot and ankle.
Since then, a number of our clients suffering with chronic pain have undergone this procedure, with varying degrees of success in terms of longer term pain relief. There are also a number of our clients who are either currently awaiting a trial of SCS, or who have decided not to proceed with SCS at this time.
There are different models of SCS, but they all work in a similar way. The procedure to fit the device is an invasive one and involves the insertion of electrodes into the epidural space in the spine. The electrodes are connected to a pulse generator/battery which delivers pulsed electrical signals to the spinal cord, which has the effect of blocking the pain signals to the brain. During the initial trial, which usually lasts a week, the leads and the pulse generator/battery are external to the body. If the trial is satisfactory and the patient wishes to proceed, the leads and a pulse generator/battery are implanted under the skin.
There then follows a post operative period, during which the device is calibrated. The SCS is controlled by way of a small remote control unit.
More pain medicine specialists now seem to be offering the SCS to patients suffering chronic pain, where more conservative treatment options have failed to achieve longer lasting benefit. An increasing number of NHS Trusts are prepared to fund the cost of around £15,000.00. Privately, the procedure costs in the region of £25,000.00.
Our client whose story was outlined in our earlier blog, has now been able to return to work, albeit not quite on his full time hours, although he still hopes that will come with time. That followed almost two years before the SCS procedure, where he was unable to work at all.
Our clients to whom the procedure has been recommended are, understandably, always apprehensive. After all, this is a major and potentially life changing procedure. By mutual agreement, we have on occasions been able to arrange for a client to whom SCS has been recommended, to speak to a client who has already been through the procedure. Whilst in no way meant to replace informed discussions with those treating them, this has nevertheless proved very helpful to clients in making what is a very difficult decision.
The very small and unscientific sample formed by our clients who have been through the SCS procedure, shows that all of them report reductions in levels of pain. However, when asked to quantify the reduction in the level of pain, responses range from “15 to 20 %” to “most of the time over 50 %” and a whole range in between.
Overall, we are having success in obtaining funding for clients to undergo the procedure privately. A small number of clients were already at an advanced stage on the waiting list for the procedure at the time that we were instructed and, therefore, opted to continue to have their procedure on the NHS.
As time goes by, more research literature is becoming available on the longer term effects of SCS. This in itself will hopefully make the difficult decision making process a little easier.