Month: September 2016

Spinal Cord Stimulation Can Improve Emotional Aspect of Chronic Pain

Spinal cord stimulation is changing lives in more ways than just the physical pain and discomfort that the procedure has been proven to ease.

While many patients who undergo the procedure report anywhere from a 50 to 70 percent reduction in physical pain, a new study suggests that spinal cord stimulation may also reduce the brain’s emotional response to pain as well.

First, let’s quickly break down the What, How, Who, and Why of spinal cord stimulation.

Spinal Cord Stimulation

What: What is Spinal Cord Stimulation?

Are you curious about what this so called “life changer” for chronic pain is? While it sounds intense and maybe even scary, it’s quite the opposite.

This effective, minimally invasive treatment is a two-step procedure.

Since pain is transmitted through the spinal cord to the brain, spinal cord stimulators work to block the transmission of pain through the spinal cord.

What is a “Spinal Cord Stimulator”?

Made up of electrical wires and a small pacemaker-like battery, a spinal cord stimulator sends electrical impulses.

These electrical impulses stimulate the spinal cord, blocking the transmission of pain from different areas of the body, such as the legs, back, arms or neck.

How: How Does Spinal Cord Stimulation Work?

The two-stage procedure consists of the spinal cord stimulator trial and the permanent placement of a spinal cord stimulator.

Step 1:

First, step one is the trial. Patients who are candidates for the procedure will initially undergo a temporary trial of spinal cord stimulation.

For the trial period, the wires are implanted into the spinal canal and come out of the skin connecting to an external computer battery.

Step 2:

Following the trial, step two involves placing the spinal cord stimulator permanently.

The spinal cord wires and “pacemaker” computer and battery are implanted usually a few weeks to a month after the trial.

Who: Who is Spinal Cord Stimulation For?

Stimulators are usually given to people who continue to have pain after spine surgery (failed back syndrome) or have nerve disease like diabetic neuropathy or chronic pain syndromes such as reflex sympathetic dystrophy.

Why: Advantages of Spinal Cord Stimulation

Some advantages of spinal cord stimulation include:

The procedure itself is minimally invasive.
There is short recovery time.
High success rates have been shown.
There is minimal to no blood loss.
It is a same-day, out-patient procedure.

Altering Pain Perception: Spinal Cord Stimulation for the Emotional Aspect of Chronic Pain

Plenty of studies show that spinal cord stimulation helps reduce chronic pain. But now, it has been shown to ease the emotional aspect of chronic pain as well.

A New Study Says it All

Researchers at The Ohio State University Wexner Medical Center have proven that patients who have chronic pain can reduce their emotional response to pain through the procedure known as spinal cord stimulation.

The researchers at Ohio State’s Neurological Institute studied 10 patients who were implanted with a spinal cord stimulator to reduce their chronic leg pain. From this, they were able to support previous suggestions that emotional, sensory, and cognitive factors also influence how pain is felt.

According to the study results that were published in the journal, Neuromodulation: Technology at the Neural Interface, the initial study provides insights into the role of the brain’s emotional networks in relieving chronic pain.

“We are the first to show that therapeutic spinal cord stimulation can reduce the emotional connectivity and processing in certain areas of the brain in those with chronic pain,” said principal investigator Dr. Ali Rezai, director of the Center for Neuromodulation.

The research builds off previous findings that proposed the concept of the neuromatrix theory of pain. The theory states that pain perception varies according to cognitive, emotional and sensory influences.

“Being able to modulate the connections between the brain areas involved in emotions and those linked to sensations may be an important mechanism involved in pain relief linked to spinal cord stimulation,” Dr. Rezai said.

More than 500,000 patients have had spinal cord stimulator implants for chronic pain, according to Dr. Rezai.

“Spinal cord stimulation is safe and effective for pain control for severe chronic pain of the extremities and other conditions. However, the mechanisms of action of spinal cord stimulation are still not well understood and this is an area of active investigation,” Dr. Rezai explained to Orthopedics This Week.

“Our team’s goal was to utilize functional MRI with spinal cord stimulation to evaluate changes in the brain networks and circuitry involved in pain perception including sensory, emotional, behavioral and cognitive regions.”

How it Works for Emotional Aspects of Chronic Pain

Spinal cord stimulation may affect how pain is perceived in certain areas of the brain for people with chronic pain.

Researchers mapped the areas of the brain involved in pain perception and modulation by using functional magnetic resonance imaging (fMRI).

Focusing on the highly interactive region of the brain—known as the default mode network, which is associated with the emotional and cognitive aspects of pain—researchers found that there is a noticeable difference in activity level for patients with chronic pain.

The difference in activity level in the DMN suggests it’s somehow impacted by persistent pain.

The Future for Spinal Cord Stimulation in the Improvement of Emotional Aspects of Chronic Pain

Using MRI scans, scientists were successful in mapping areas of the brain that seem to be affected by impulses released by the implanted device used in the procedure.

Researchers now hope that understanding how the DMN region of the brain reacts to pain can lead to advances in pain control.

“If we can understand neural networks implicated in the pathophysiology of pain, then we can develop new therapies to manage chronic persistent pain,” said Dr. Milind Deogaonkar, an Ohio State neurosurgeon who specializes in neuromodulation.

How Will You Know if Spinal Cord Stimulation Right for You?

If determined an ideal candidate for the procedure, a patient will then go through the trial period, which usually lasts for about a week.

If you experience at least a 50 percent reduction in your pain following the trial, the device will be used long term.

Although the level and frequency of the electrical impulses delivered from the device are pre-set initially, the patient later controls it himself or herself.

Spinal cord stimulation helps lead to more active, fulfilling lives for many patients.

Does the procedure seem like something you would like to try yourself?

Anterior and Posterior Spinal Fusion: What to Expect for Your Surgery

When your doctor recommends a surgery called anterior and posterior spinal fusion, you have a right to be a little nervous. Those are a bunch of scary sounding words that only a fool would take casually.

By this point, you have already tried a spinal nerve block injection. But the pain is persistent.

Naturally, you have questions if you or someone you love is up for that particular procedure. Of course, you have asked your doctor all the questions that came to mind at the time. But that is never enough. The really good questions don’t occur to you until much later.

This article is no substitute for a conversation with your surgeon. But, having already had that conversation, this should help fill in some of the gaps.

What you really want to know is that at the end of the process, everything is going to be all right. There is good news. For this procedure, the fusion rate is greater than 95%. You are most likely going to be just fine.

But to get from where you are to being just fine, there is a road on which you must travel. That’s the scary part. The truth is always less frightening than the nightmare conjured by your worst fears. Knowing exactly what to expect is a great way to tame the beast. Here is what you can expect from your surgery:

Anterior and Posterior Spinal Fusion (Timetable)

Anterior and posterior spinal fusion is major surgery. Here are some numbers associated with the surgery:

8 – 12 hours: The amount of time the surgery takes
7 days: The expected hospital stay after surgery
4 days: The amount of time the chest tube is in
20 minutes: The maximum time you can sit up per session shortly after surgery
14 days: The minimum time before the staples are removed
6 months: The amount of time for the fusion to become solid

There are other numbers that fall into the category of “to be determined (TBD).” Those numbers include the time elapsed before you can return to work. All of these numbers make a lot more sense once you realize what the surgery involves.

Anterior and Posterior Spinal Fusion (Procedure)

As with most surgeries, you are not to eat or drink anything after midnight prior to surgery. It is a very long procedure done in two parts. Studies show it is better to have these parts done as a continuous procedure than staged over time.

There will first be some bone removed from your hip to be used in the fusion. From there, the anterior portion of the procedure will begin.

The Anterior Lumbar Interbody Fusion consists of an abdominal incision, and repositioning of major blood vessels to expose the damaged disk.

That disk is removed and replaced by the bone material. If normal spinal compression is not enough to hold the bone in place, a screw may be used.

Once this portion of the surgery is completed, you are turned over for the remainder of the procedure.

More disk material is removed, and more bone grafts are performed. More hardware such as rods and plates are applied as determined by the doctor.

It is normal for an NG tube to be inserted to prevent you from being sick afterward. Also, expect a chest tube to be inserted. This will aid in diagnostics for the first few days you are in the hospital.

It is not important that you have an encyclopedic knowledge of the surgical details. The takeaway is that these procedures are not new. They are tried and true. You should take comfort from the fact that these details are common knowledge. It has been successfully done countless times before you experience it.

Recovery

Anterior and posterior spinal fusion is major surgery. Expect recovery to be a process commensurate with the procedure.

You will have been on an operating table for several hours, and opened in the front and back with internal plumbing temporarily pushed aside for access. Expect a bit of discomfort while you heal.

There will be some period when you are forbidden to lift anything heavier than a gallon of milk. Expect some inconvenience.

There will be a period of time when you are forbidden to take more than a flight of stairs in a single day. Return to work will be at the doctor’s discretion. And you will need to wear a brace for a while. Expect some limited mobility.

In this way, all major surgery is the same: The initial recovery period is the darkest, scariest, most frustrating, and most depressing time of the procedure.

While managing pain that seems like it will never end, you are relearning how to walk, eat, and perform functions you once took for granted.

This is the period when the doctor is telling you that everything looks great. But you feel like everything is broken, and will never get better. This is normal. Everyone goes through it to some degree.

It takes a while, but it does get better. Eventually, you will have a quality of life you didn’t dream possible. The details of recovery are much like the details of surgery. There is a time-honored process that will lead to a better life.

Other Considerations

It is important for your loved ones to know as much about what to expect from the procedure as you do. That is because they will be taking care of you while you recover.

Some relationships can be severely challenged due to the added stress of convalescence. Some of those stresses are financial. Even if insurance covers every penny of the surgery, you have to be prepared to be without your income until you can return to work.

If your line of work is what caused your issues leading up to surgery in the first place, you might have to consider a new line of work (if not early retirement).

This stress can be relieved by having some type of financial plan in place to deal with the possibility of lost income.

It might also be prudent to arrange some counseling during recovery, It is not unusual for patients recovering from major surgery to go through some situational depression due to lost mobility, income, and body image.

The best defense against these types of post-op stresses is knowledge. Consult your surgeon. Dr. Carl Spivak is a board-certified Neurosurgeon and President of Executive Spine Surgery P.P.C. He’s here to help you.

Get a realistic handle on the timetable. Learn about the procedure. Set yourself up for recovery success. And don’t try to go it alone. Involve family and friends, because love is always the best medicine.