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• Patients who are psychologically stable and have realistic expectations regarding further treatment and prognosis
• Patients who have had a favorable response to sympathetic nerve blocks but need more intense pain relief

If the patient is deemed a candidate for SCS, it is important to perform the procedure in a timely manner since waiting too long may diminish the success of the treatment.

Potential risks and complications associated with surgical implantation of the spinal cord stimulator include:

• Infection
• Headache
• Bleeding
• Spinal cord injury
• Failure to relieve pain
• Pain at the site of the implant
• Hardware malfunction

Contraindications to the use of SCS include:

• Patients with implantable devices such as a pacemaker or defibrillator
• Patients undergoing radiation therapy
• Patients who are exposed to detection equipment devices including anti-theft devices, security devices, and aircraft communication systems

Patients who have an implanted SCS device should not drive or operate heavy equipment while the device is activated. They should also carry special identification papers through security systems (such as airports) since the system can activate metal detectors.

Since being introduced in the 1960s, spinal cord stimulation fell out of favor but with recent advances in technology, it is being re-evaluated for its efficacy in treating chronic pain. Data is limited but there is evidence of efficacy of spinal cord stimulation. In 2000, a study was published in the New England Journal of Medicine and reported that a group of patients with RSD who had been treated with SCS and physical therapy experienced significant reduction of pain and increased quality of life compared to a group that was given physical therapy alone. Functional outcome in terms of day to day use of the affected limb, however, was no better than the group who had received physical therapy alone.

To read more about this please click on the following link: http://www.ncbi.nlm.nih.gov/pubmed/10965008

Spinal cord stimulation has been approved by the US Food and Drug Administration (FDA) as a treatment for RSD. The FDA approved the ANS Renew and the Medtronics Mattrix systems for SCS delivery.

Implantable Spinal Pumps

Implantable spinal pumps provide a way of delivering drugs intrathecally, the administration of drugs directly into the spinal fluid. Medications are delivered within the intrathecal space (the space surrounding the spinal cord) by either injection through a needle or via a catheter that is connected to a pump. Doses can be programmed to be delivered continuously at a particular rate which can be increased or decreased, or on a schedule controlled by the patient. Medications can be opioid or non-opioid but morphine is the "gold standard" drug used in the implantable spinal pump. If the patient cannot tolerate morphine, other drugs such as baclofen or ziconitide may be tried. Long-term experience with the morphine pump in patients with chronic pain, including those with RSD, indicates few advantages over oral morphine administration. In fact, many patients with implantable morphine pumps also require oral morphine supplementation to control their pain. The implantation of a morphine pump is also associated with potential complications including: