for chronic pain relief.
pain treatments
pain treatment
persistent pain
technology mean there are
now better solutions for
chronic pain relief.
pain treatments
pain treatment
Spinal cord stimulation
SCS is the electrical stimulation over the dorsal aspect of the spinal cord for the relief of pain. It is an implanted device akin to cardiac pacemaker/defibrillator.
It is an established treatment within the UK and is funded by the NHS for neuropathic pain. It can also be used to treat ischaemic (refractory angina and chronic critical limb ischaemia) and visceral pain (chronic abdominal pain) although not funded by NHS.
The patient process
Check-up & Diagnosis
Patients who are considered for SCS have generally had chronic pain for more 6 months. Chronic pain has a physical and emotional impact, so generally the sufferer has complex needs that need to be evaluated. First the correct medical diagnosis and pain mechanism is understood, and then the psychological impact is evaluated.
Take me to the next processResearch and development
I have been at the centre of UK and International SCS research, both in establishing SCS as a treatment available to NHS patients and seminal research informing the development of sub-perception SCS.
Read more about my research
Looking for medical help?
If you suffer from severe chronic
pain, fill out the quick online
questionnaire to discover what
treatment could work best
for you.
Spinal Cord Stimulation
SCS is the electrical stimulation over the dorsal aspect of the spinal cord for the relief of pain. It is an implanted device akin to cardiac pacemaker/defibrillator.
It is an established treatment within the UK and is funded by the NHS for neuropathic pain. It can also be used to treat ischaemic (refractory angina and chronic critical limb ischaemia) and visceral pain (chronic abdominal pain) although not funded by NHS.
The patient process
Treatment plan
The idea is to not only determine if you are good candidate for SCS but also to support you through the process of health improvement. This might include learning better pain coping styles, reducing dependency on habit forming medication and learning to restore physical function.
There are 6 different manufacturers of spinal cord stimulation marketed within the UK. They all work but each have unique features. I use Boston Scientific Neuromodulation and Saluda Medical. BSN Wavewriter Alpha offers both precise targeted paraesthesia SCS and a range of sub-perception SCS. This means that the SCS can be more precisely tailored to each patient’s needs.
Saluda Medical offers closed loop feedback. The device not only stimulates the nerves in the spinal cord but also measures the effect of doing so – the Evoked Compound Action Potential (ECAP). Closing the loop means that the activation stimulation remains the same no matter if you cough, stretch or bend. This ensures that optimal paraesthesia coverage is maintained giving optimal pain relief.
Both are excellent SCS systems with great outcomes. I can discuss with you at consultation to help you decide.
Research and development
I have been at the centre of UK and International SCS research, both in establishing SCS as a treatment available to NHS patients and seminal research informing the development of sub-perception SCS.
Looking for medical help?
If you suffer from severe chronic
pain, fill out the quick online
questionnaire to discover what
treatment could work best
for you.
Spinal Cord Stimulation
SCS is the electrical stimulation over the dorsal aspect of the spinal cord for the relief of pain. It is an implanted device akin to cardiac pacemaker/defibrillator.
It is an established treatment within the UK and is funded by the NHS for neuropathic pain. It can also be used to treat ischaemic (refractory angina and chronic critical limb ischaemia) and visceral pain (chronic abdominal pain) although not funded by NHS.
The patient process
Therapy education
Apart from agreeing to SCS, there is much to learn. This therapy is iterative. You will learn how to use it over the coming months. You may need to learn how to taper your medication and how to develop your improving function.
Your further reading about SCS may have touched on the concept of a prolonged temporary trial of SCS to guide the decision on later implant. My own randomised clinical research trial, backed by over 7 years of real world SCS activity proves to me that a prolonged clinical trial of SCS is unhelpful in predicting long term benefit, so I know longer do this as a routine. You do have an on-table trial, that allows proper targeting of the therapy. If that cannot be achieved, the procedure is abandoned.
SCS outcomes have got better owing to new technologies and careful selection of patients. However, be prepared to visit the clinic 4 or 5 times until full optimisation of SCS is reached. There are so many changes that occur in that first 6 to 12 months – healing, programming, drug tapering, physical and mental rehabilitation. An annual check-up is ideal. Check with your Private Medical Insurer or self-pay for follow-up consultation. Unfortunately, Private Medical Insurers may fail to reimburse for follow up appointments beyond 3 months.
I tend to use rechargeable devices that have a life expectancy of up to 12 years before the implantable pulse generator needs replacing. But non-rechargeable are available.
Research and development
I have been at the centre of UK and International SCS research, both in establishing SCS as a treatment available to NHS patients and seminal research informing the development of sub-perception SCS.
Looking for medical help?
If you suffer from severe chronic
pain, fill out the quick online
questionnaire to discover what
treatment could work best
for you.
Spinal Cord Stimulation
SCS is the electrical stimulation over the dorsal aspect of the spinal cord for the relief of pain. It is an implanted device akin to cardiac pacemaker/defibrillator.
It is an established treatment within the UK and is funded by the NHS for neuropathic pain. It can also be used to treat ischaemic (refractory angina and chronic critical limb ischaemia) and visceral pain (chronic abdominal pain) although not funded by NHS.
The patient process
Implant procedure
The procedure can be done as a day case but nicer if you can stay overnight. It will be at The London Clinic. The procedure is under local anaesthetic, but with an anaesthetist attending, balanced sedation is achieved. I need you to be awake to feedback the sensation areas (parasthesia topography) so that I can adjust for optimal lead position. Once OK, I carefully anchor a collar around each lead to the surface of muscles under the skin of the mid-back. I connect this to the implantable pulse generator in your flank. Wounds closed with absorbable stitches and waterproof dressing. You are discharged the next day and will have an appointment with me 10 days later to programme device, check wound healing and continue the iterative process.
How SCS works
How to use your charging system
How to use your remote control
How Spinal Cord Stimulation (SCS) Works
How Closed-Loop SCS Works (Part 1)
How Closed-Loop SCS Works (Part 2)
Research and development
I have been at the centre of UK and International SCS research, both in establishing SCS as a treatment available to NHS patients and seminal research informing the development of sub-perception SCS.
Read more about my researchLooking for medical help?
If you suffer from severe chronic
pain, fill out the quick online
questionnaire to discover what
treatment could work best
for you.
Multifidus nerve stimulation - MFS
The multifidus muscle is the important ‘core muscle’ of the low back (The mainstay). Primary and secondary muscle motor/sensory dysfunction of this muscle group is responsible for most low back pain.
MFS is the activation of the multifidus muscle by stimulating the nerve end plate as it enters the anterior surface of the muscle. Direct nerve stimulation ensures FULL but gentle tonic contraction of the muscle. Over time this activation restores normal motor/sensory control overcoming the dysfunction, rehabilitating the core muscles and reducing or eliminating back pain.
The patient process
Check-up & Diagnosis
Some patients’ lives are dogged by chronic/continuous or severe frequent recurrent episodes of low back pain. Many will get temporary benefit from physical therapy or even targeted injections. It is this group who appear to do well with MFS. The patient needs to accept using a lifelong implant; it is a restorative therapy that treats the underlying condition of chronic back pain.
Diagnosis and appropriateness of MFS for your back pain is based upon cardinal features of narrative history and back examination. The Prone Instability Test shows how when multifidus is activated your back pain is improved. MRI scan can reveal the typical grade 2/3 fat infiltration of multifidus.
Research and development
Much of the early research of this therapy has been done within the UK. I have been involved in the post marketing clinical follow-up study which will follow several patients for 5 years.
Multifidus nerve stimulation - MFS
The multifidus muscle is the important ‘core muscle’ of the low back (The mainstay). Primary and secondary muscle motor/sensory dysfunction of this muscle group is responsible for most low back pain.
MFS is the activation of the multifidus muscle by stimulating the nerve end plate as it enters the anterior surface of the muscle. Direct nerve stimulation ensures FULL but gentle tonic contraction of the muscle. Over time this activation restores normal motor/sensory control overcoming the dysfunction, rehabilitating the core muscles and reducing or eliminating back pain.
The patient process
Implant procedure
Under local anaesthesia and deep sedation, two leads of electrode contacts are injected at the 3rd lumbar transverse process so as to stimulate the nerve to multifidus. These are connected to an implantable pulse generator. These are tested and then implanted under the skin and fat layer of the low back. Once healed the device is programmed so that when activated by the patient it can deliver a sequence of gentle contractions for half an hour morning and evening.
Research and development
Much of the early research of this therapy has been done within the UK. I have been involved in the post marketing clinical follow-up study which will follow several patients for 5 years.
Multifidus nerve stimulation - MFS
The multifidus muscle is the important ‘core muscle’ of the low back (The mainstay). Primary and secondary muscle motor/sensory dysfunction of this muscle group is responsible for most low back pain.
MFS is the activation of the multifidus muscle by stimulating the nerve end plate as it enters the anterior surface of the muscle. Direct nerve stimulation ensures FULL but gentle tonic contraction of the muscle. Over time this activation restores normal motor/sensory control overcoming the dysfunction, rehabilitating the core muscles and reducing or eliminating back pain.
The patient process
Treatment plan
After the leads and device have been implanted, a two-week period is allowed before switching on the device. This allows healing.
Usually I see each patient at 2, 6 weeks, 3, 6 months and one year. Following that it will annually or as required basis. Pain relief, functional improvement may occur by 3 months in the many, but others may take 6 to 12 months.
It is a restorative therapy, treating the cause of your back-muscle dysfunction. It has taken years to get as bad as it has, it takes time to improve. Check with your Private Medical Insurer or self-pay.
Research and development
Much of the early research of this therapy has been done within the UK. I have been involved in the post marketing clinical follow-up study which will follow several patients for 5 years.
@drsimonthomson