If you have been in pain for more than 6 months and your current treatment has not provided adequate relief, or you’re experiencing intolerable side effects, don’t lose hope. Spinal cord stimulation (also known as neurostimulation therapy) may be an option for you.
What Patients Have to Say About Neurostimulation
Neurostimulation Therapy Since 2009"I knew right away when they put the leads in me and had the battery connected, and I turned it on. I knew right away that my pain was going to be controlled."
What Can I Expect From the Screening Trial?
If you are considering spinal cord stimulation to control your pain, think about having a screening trial. With this trial, you will have a reasonable idea of what your results might be before you have the device implanted.
During the trial, you can:
- Assess how well the spinal cord stimulator relieves your pain during different activities
- Understand how the system components work and feel the varied levels of stimulation that the system can provide
- Decide if you want to go on to have the long-term therapy
The Screening Trial
Dr. David Provenzano
Pain Management Specialist, Pennsylvania"Unlike other surgeries where you have to guess what your final outcome’s going to be, the trial stage really lets you see whether this treatment’s for you."
What Happens During the Spinal Cord Stimulation Screening Trial?
You can experience spinal cord stimulation on a trial basis to find out how well it reduces your pain and how well it helps you achieve your pain management goals.
- An external neurostimulator mimics the therapy delivered by an implanted device.
- A handheld, wireless programmer lets you adjust the stimulation levels to best control your pain.
- It’s important to keep track of your pain before and after the screening trial. This will help assess your response to spinal cord stimulation.
- Use the Pain and Activity Diary to help describe when and where your pain occurs.
You can try a temporary system to see if spinal cord stimulation will work for you. During the up to 10-day trial, you will find out how much it reduces your pain, and how well it helps you achieve your pain management goals.
The temporary system consists of these components:
- The external neurostimulator, which generates mild electrical pulses and is worn on your waistband
- The screening cable, which connects to thin insulated medical wires that are placed in the epidural space of your spine to deliver electrical pulses from the neurostimulator to the nerves along the spinal cord
- The pouch, which holds your temporary external neurostimulation system and clips onto your waistband so you can go about your daily activities
- The handheld, wireless programmer that works like a remote control and allows you to adjust the stimulation levels
What Can I Expect During the Procedure?
Your screening trial procedure will likely take place on an outpatient basis in the doctor’s office, day surgery center, or hospital. You may be able to go home on the same day as the procedure.
Generally, these are the steps your doctor may take during the procedure:
- You may be given a local anesthetic to keep you comfortable.
- You will be placed on your stomach on a surgical table.
- Your back will be cleaned with a solution.
- A special needle will be used. Instead of injecting medication into the epidural space (an area near your spine), medical wires called leads will be placed.
- Your doctor will use fluoroscopy (x-ray) to evaluate the position of the leads in the epidural space.
- The leads communicate with a screening cable and the external neurostimulator.
- Your doctor will ask you questions about the stimulation you are feeling and where it is located to be sure the leads are in the best location.
- The leads will be taped or secured to your back for the duration of the trial.
- You will be taken to a recovery room until it is time to go home.
What Can I Expect After the Procedure?
In the recovery room, your care team will work with your doctor to program the external neurostimulator to provide you with the greatest amount of relief.
You will be taught:
- How to use the handheld programmer to adjust your stimulation and determine what settings you prefer for pain relief
- How to care for the area around the leads
- What activities and movements to avoid during the screening trial
You may experience some discomfort in your back where the needle was placed. This is temporary and should resolve in the hours and days following the procedure.
After the trial, you and your doctor will decide if long-term therapy is right to help manage your chronic pain.
At Home With Your Temporary Neurostimulation System
You will be sent home with your temporary neurostimulation system for up to 10 days, depending on your doctor’s preference. During this time, you will be supported by your doctor for medical concerns and your care team for device-related questions. If you have any questions, they are just a phone call away.
When you are home, go about your normal activities, as this will help you and your doctor evaluate how well the spinal cord stimulation addresses your pain.
During the screening trial, your doctor will want to know if the stimulation is:
- Reducing your pain and, if so, by how much
- Improving your ability to perform daily activities
- Allowing you to reduce or eliminate your pain medications
- Improving your sleep habits
It will be helpful to your doctor if you keep track of the results you are getting from spinal cord stimulation. Go to the Pain Journal.
Evaluating Your Response
Dr. David Provenzano
Pain Management Specialist, Pennsylvania"Things you should look for during the trial are, one, is it helping with your pain? Two, is it helping improve your function? Three, do you find the stimulation pleasant?"
If you are not receiving adequate relief, your doctor can adjust your settings. By simply having your settings changed, you may have better pain relief during your screening trial.
During the screening trial your doctor may restrict certain activities, such as:
- Taking a shower or bath or submerging your body in water (you may have a sponge bath)
- Physical activity levels that are more than moderate
- Lifting more than 5 pounds
- Reaching over your head, turning side to side, stretching, climbing, or extended reaching
- Bending forward, backward, or from side to side
- Climbing too many stairs or sitting for too long at one time
- Sexual activity
- Operating power equipment or heavy machinery
- Having your back manipulated by a chiropractor or a healthcare provider
If you are uncomfortable during the screening trial, you can have the system removed.
Complications can occur with the screening trial and may include infection and movement of the leads within the epidural space. Please discuss the benefits and risks of the screening trial with your doctor.
What Can I Expect After the Screening Trial?
By the end of the trial, you’ll have a complete understanding of the benefits of spinal cord stimulation. If you went through the SelectStim Screening Trial, you'll also know which settings relieved your pain most effectively.
At the end of your screening trial, your doctor will:
- Remove the temporary neurostimulation system
- Discuss your experience during the screening trial
- Ask you if you were satisfied with your experience with spinal cord stimulation
- Help you determine if you should proceed with the long-term therapy
If you decide to proceed with long-term spinal cord stimulation, in most cases there will be a waiting period after the screening trial and before your implant procedure. This will give the area in your back where the needle was placed time to heal, for your insurance provider to be notified, and for the surgery to be scheduled.
How to Get a Screening Trial
If you think spinal cord stimulation might help you relieve your chronic back pain and get back to a fuller life, the first step is to talk to your doctor or pain management specialist.
Your pain management specialist can help you schedule a trial for the therapy that is most appropriate for your needs. Be sure to discuss the risks and benefits of the screening trial and long-term spinal cord stimulation therapy.
Talk With Someone Who is Receiving Spinal Cord Stimulation
Before or during your screening trial, it can be helpful to talk with someone who has been living with spinal cord stimulation. The Medtronic Ambassador Program for prospective patients puts you in touch with a volunteer who is interested in sharing their experience with you.