FAQs on Spinal Cord Stimulation for Peripheral Vascular Disease Pain

FAQs on Spinal Cord Stimulation for Peripheral Vascular Disease Pain

Apart from neuropathic and nociceptive pain, spinal cord stimulation is also an excellent method to manage ischemic pain, including peripheral vascular disease. Research studies indicate complete or marked relief from painful cramping, discomfort, and achiness associated with peripheral vascular disease. It also improves blood flow and tolerance to exercise.

What is peripheral vascular disease?

Peripheral vascular disease refers to reduced blood supply to areas other than heart and brain causing pain and discomfort.  This occurs when peripheral blood vessels feeding arms, legs, and organs below the abdomen become narrower due to plaque buildup. Decreased supply of blood deprives lower extremities of oxygen and causes pain.

How common is peripheral vascular disease?

About 10% to 15% Americans above 40 years are diagnosed with peripheral vascular disease. The incidence is higher in the 60+ age group. Those with diabetes, high cholesterol, high blood pressure, or regular smoking habits face increase threat of being diagnosed with the disease.

What are the pain symptoms caused by peripheral vascular disease?

About 50% of those with peripheral vascular disease do not experience any painful symptom. Others may have the following symptoms.

  • Pain in muscles while walking or climbing stairs
  • Pain in feet while elevated
  • Painful cramping in legs
  • Aching pain in legs and feet

How does a spinal cord stimulator implant help manage pain caused by peripheral vascular disease?

  • Pain relief when electrical signals generated by SCS disrupt pain signal transmission
  • Suppression of sympathetic nerve activity by stimulating nerves
  • Antidromic stimulation of nerves to alter pain sensation-carrying function
  • Improved blood flow
  • Increased tolerance to exercise.

How effective is spinal cord stimulation to treat pain associated with peripheral vascular disease?

Spinal cord stimulation offers complete or very marked relief from pain, improves blood circulation, increases claudication distance, betters exercise tolerance, and increases limb survival. It is 80% beneficial for patients suffering from pain and disability due to peripheral vascular disease.

Research findings attest clinical efficacy of SCS therapy in creating better anti-ischemic effect at lower cost.  A 2004 European meta-analysis evaluated nine trials and concluded that spinal cord stimulation was helpful in preventing amputation of limbs affected by peripheral vascular disease. It also found SCS therapy providing significantly better pain relief in both amputated and non-amputated patients.

According to a 2013 research report, spinal cord stimulation is beneficial in providing pain relief and improving blood circulation through peripheral blood vessels.  

A 20-year clinical study claims 88% success rate of spinal cord stimulator implant in controlling pain and disability in patients suffering from peripheral vascular disease.

How is a spinal cord stimulator implant procedure done?

First, a patient undergoes a trial test to check the benefits of spinal cord stimulation. If the trial provides significant pain relief (at least 50%), he or she is considered for a permanent SCS implant.

What is done during the trial spinal cord stimulator implant?

Using local anesthesia, doctors place electrode leads adjacent to the spine. A soft, thin wire, the lead is put through a needle. The patient wears the spinal cord stimulator connected to the lead.

The device is operated at a specific time and intensity depending on the patient-specific requirement.

How long does the trial take?

The trial goes for 5 to 7 days and the pain relief is assessed.

How is the permanent SCS implant performed?

General anesthesia is used during permanent spinal cord stimulator implant, as it is an invasive surgery. A small incision is made to place electrodes in the epidural space. Another incision is made just above the buttock and the stopwatch-sized SCS device is placed under the skin. Wires passing through soft tissues connect electrodes with the device. Incisions are closed after a test run.

What can I expect after the implant procedure?

The spinal cord implant is an outpatient procedure and patients are discharged after a brief monitoring.  Soreness and discomfort at surgery site is common. You can experience immediate relief from pain associated with peripheral vascular disease.

How long does it take?

The surgery takes about 2 to 3 hours.

What are post-surgical precautions?

  • Takes rest for a week
  • Keep the incisions dry and clean
  • No driving for 4 weeks
  • No running, swimming, twisting, bending, weight lifting, or intense activities for 6 weeks
  • Avoid pressure on the implant site
  • No stressful work for 6 weeks
  • Avoid raising hand over head for 6 weeks

Do I need to replace the spinal cord stimulator?

It is a life-time procedure and you do not need to replace the spinal cord stimulator as long as you will have pain relief from symptoms associated with peripheral vascular disease. All that you need is to replace the battery of the device after 5 to 8 years depending on the usage.

How can I control the spinal cord stimulation?

The device comes with a small remote control. You can control, operate, program, regulate, and manage the spinal cord stimulation for peripheral vascular disease using this hand-held remote control.

What are side effects of spinal cord stimulator implant?

Spinal cord stimulator implant to manage pain associated with peripheral vascular disease does not lead to any major health hazard.  However, implant surgery could cause infection, bleeding, nerve damage, and surgical complications. Spinal headache, cerebrospinal fluid leakage, and bladder movement disorder, though are rare, may be there.

References

Ubbink DT, Vermeulen H, Spincemaille HJJ, et al. Systematic review and meta-analysis of controlled trials assessing spinal cord stimulation for inoperable critical leg ischemia. Br J Surg. 2004;91:948-55.

Reig E, Abejon D. Spinal cord stimulation: a 20-year retrospective analysis in 260 patients. Neuromodulation. 2009 Jul;12(3):232–9.

De Vries J, De Jongste MJ, Spincemaille G, et al. Spinal cord stimulation for ischemic heart disease and peripheral vascular disease. Adv Tech Stand Neurosurg. 2007; 32:63-89.

R C Tallis, L S Illis, E M Sedgwick, et al. Spinal cord stimulation in peripheral vascular disease. J Neurol Neurosurg Psychiatry. 1983 Jun; 46(6): 478–484.

Amann W, Berg P, Gersbach PA et al. Spinal cord stimulation in the treatment of non-reconstructable stable critical leg ischaemia: results of the European peripheral vascular disease outcome study (SCS-EPOS). Eur J Vasc Endovasc Surg. 2003; 26:280-286

Horsch S, Schulte S, Hess S. Spinal cord stimulation in the treatment of peripheral vascular disease: results of a single-center study of 258 patients. Angiology. 2004 Mar-Apr;55(2):111-8.

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