DECATUR – Ellen Miller could feel the difference as soon as she got home from the hospital nine years ago and climbed up the three steps from her garage to her house.
“It didn't hurt,” she said.
Her trial with neurostimulation just hours old, that's how quickly the Decatur woman knew an electrical stimulator would be the answer to the agonizing back pain she'd long suffered from three bad discs.
Surgery carried the risk of paralysis, and she rejected the idea of getting a morphine pump.
“They told me to expect a 50 percent reduction in my pain with the stimulator,” Miller said. “I think I got 80 (percent).”
Thanks to technological advances and concern about dependence on narcotics, implantation of a device like those that power pacemakers is an option being offered to more people.
Dr. John Furry, director of the Pain Medicine Center at HSHS St. Mary's Hospital, and Dr. Atiq Ur Rehman, director of the Decatur Memorial Hospital Millenium Pain Center, said they are implanting stimulators at least twice as often as they once did.
Furry, who performed Miller's surgery in 2007 and replaced the pulse generator's rechargeable batteries for the first time eight years and seven months later, on Nov. 3, said conclusions by the national Neuromodulations Appropriateness Consensus Committee in 2104 are what opened the door to more patients.
“Neurostimulation used to be relegated to someone who had tried everything else; medication, physical therapy, sometimes even surgery,” Furry said. “Now this therapy belongs before you go to long-acting and strong opioid medications and has a better success rate as a result.”
Rehman said people suffering from diabetic nerve pain and peripheral vascular disease are now candidates for the treatment, in addition to people suffering from complex regional pain syndrome and those for whom back surgery has failed to give them sufficient pain relief.
The treatment can be used for limb, back, neck and other torso pain.
“The best successes with the stimulator are with neuropathic, or nerve, pain,” Rehman said. “It may be associated with numbness, tingling and, sometimes, burning.”
It does not address pain caused by arthritis, headaches, a broken bone or other fresh injury, for example.
Patients are carefully selected and undergo a weeklong trial with pulse generator worn outside the body and connected to electrodes surgically placed in the spinal column. Sedation is used so the patient can be awakened during the procedure to report what the stimulation feels like and where he or she is feeling it.
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Furry and Rehman use a needle to insert the trial electrodes then remove everything once the trial is over. After the patient heals for a couple of weeks, the surgeon then makes two incisions during a second procedure to place the permanent electrodes, wires and stimulator inside the body.
The patient must again be awakened during surgery and usually goes home the same day.
Both surgeons currently implant Medtronic equipment that allows the patient to safely undergo an MRI later. Other stimulators contain metal, also requiring them to avoid passing through metal detectors.
Rehman said he prefers the aforementioned three-step method (insertion, removal and implantation) over a two-step method that involves inserting permanent electrodes through an incision for the trial. He said the risk of infection is higher from the wires coming outside of the body.
Neurostimulation uses electrical impulses to control pain, but no one completely understands why it works.
Furry said one theory holds that the pulses activate sensory cells in the spinal cord that suppress pain. Rehman said Millennium Pain Centers are using tiny leads made by Boston Scientific and implanted in rats to better understand the process.
Rehman said another manufacturer called Nevro Corp. has even developed a stimulator that uses a frequency too high for the patient to feel that is still effective at reducing their pain.
In any case, the surgeons say a vast majority of patients undergoing a trial find significant pain relief from neurostimulation and choose to have a pulse generator implanted.
Miller, 75, said her back still forces her to put limits on lifting and on standing and sitting for long periods but she spends less time resting with a heat pad and more time doing the activities she enjoys.
These include walking two miles a day and volunteering in DMH's surgery waiting room, in St. Mary's Foundation Department and at St. John's Lutheran Church.
Miller said she likes being able to control the stimulation with a remote, and because she must reduce the power to lie down and she's comfortable in that position anyway, she turns off the device while sleeping.
She recharges the batteries every two or three weeks with a special belt she wears around her waist.
“I feel better when I'm out and doing things,” Miller said. “To be able to do things without being in pain, that's a miracle to me.”