Recovery After Spinal Cord Stimulation Trial

A successful trial is an essential precursor for the permanent implantation of a spinal cord stimulator. The trial phase of spinal cord stimulation (SCS) treatment involves a relatively simple injection procedure. ¹ Dydyk AM, Tadi P. Spinal Cord Stimulator Implant. [Updated 2022 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555994/ While patients can return home soon after the procedure, getting used to the new device may cause some level of discomfort and uneasiness.

How Long an SCS Trial Lasts

The SCS trial phase lasts for 3 to 7 days, on average. ¹ Dydyk AM, Tadi P. Spinal Cord Stimulator Implant. [Updated 2022 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555994/ The trial is designed to determine the treatment's efficacy and the patient's device tolerance before a permanent implant is done.2 The goal is to evaluate if the patient experiences at least a 50% reduction in pain and/or 50% improvement in functionality–which is considered a successful trial. In such cases, patients may continue with a permanent implant, if the surgeon approves. ² Garcia K, Wray JK, Kumar S. Spinal Cord Stimulation. [Updated 2022 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553154/

Activity restrictions apply to both the trial phase and the permanent implant.

What Happens in a Spinal Cord Stimulation Trial: Surgical Process

The trial is performed as an outpatient procedure in an operating room. The entire procedure may take an hour to 90 minutes.

• The patient is sedated and through a sterile procedure, an epidural needle is inserted into the skin over the area to be treated (back or neck). ² Garcia K, Wray JK, Kumar S. Spinal Cord Stimulation. [Updated 2022 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553154/
• A lead (wire) is inserted into the epidural space (fluid-filled space surrounding the spinal cord) by passing it through this needle. ² Garcia K, Wray JK, Kumar S. Spinal Cord Stimulation. [Updated 2022 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553154/
• Under fluoroscopic (live x-ray) guidance, the needle is advanced into the body near the spine.
• The lead is advanced to the appropriate location of pain. ² Garcia K, Wray JK, Kumar S. Spinal Cord Stimulation. [Updated 2022 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553154/
• More than one lead may be inserted if several locations are identified as pain sources. ² Garcia K, Wray JK, Kumar S. Spinal Cord Stimulation. [Updated 2022 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553154/
• After the leads are placed in the epidural space, the needle is removed. ² Garcia K, Wray JK, Kumar S. Spinal Cord Stimulation. [Updated 2022 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553154/
• The lead is then secured to the skin using a suture, surgical adhesive, or skin glue. ² Garcia K, Wray JK, Kumar S. Spinal Cord Stimulation. [Updated 2022 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553154/
• The remaining parts of the wire are connected to a pulse generator (also called neurostimulator), which is adhered to the skin using a suture or skin glue, an antiseptic patch, and a dressing. ² Garcia K, Wray JK, Kumar S. Spinal Cord Stimulation. [Updated 2022 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553154/ The pulse generator is about the size of a wallet.

The patient's vital signs are monitored until the effect of the sedation wears off (about 30 minutes to an hour). The pulse generator device is programmed, and the patient is discharged. A manual, handheld device helps program the pulse generator. The patient is instructed on how to use this device at home for SCS treatment.

It is not advisable for patients to drive home after the procedure. Arranging for a friend or family member to drive is recommended.

Recovering at Home After a Spinal Cord Stimulation Trial

The trial phase of SCS does not include the surgical implantation of the pulse generator. Only the leads are inserted into the epidural space. This setup is temporary, and patients may feel slight discomfort or soreness at the site(s) where the needle was inserted into the skin.

Soreness may be treated with ice packs or topical pain medication if approved by the doctor. It is advisable to rest for 1-2 days after the insertion of the leads while the body adjusts to the new treatment.

Activity Restrictions During the SCS Trial Period

Activity restrictions help provide better treatment outcomes and protect the device.

• No full baths or showers. Since the pulse generator device is secured outside the body, care must be taken to not get the device in contact with water. Patients are instructed to take a sponge bath and avoid showers, full baths, or water activities.
• No strenuous physical activities. Engaging in heavy or strenuous physical activities is discouraged due to the risk of migration or breakage of the leads.
• Move with caution. Bending, twisting, stretching, and raising the arms above the shoulder level can cause the leads to migrate, so these movements must be restricted as much as possible.
• Driving restrictions. When the stimulator is turned on, driving and other activities requiring focus, such as operating machinery should not be performed.

Medications must be taken in a timely manner during the recovery period. A combination of pain-relieving medication and antibiotics is usually prescribed. All medications must be taken as directed. If the medication does not help with pain reduction or if any concerning symptoms occur, the physician should be consulted as soon as possible.

Maintaining a Pain Journal

Doctors advise patients to maintain a daily pain journal during the trial phase (and sometimes even after the permanent implant) that records any changes in symptoms during the treatment. Patients typically record answers to questions such as the following:

• Was there an improvement in pain? How would you grade the improvement on a scale of 0-10?
• Was there an improvement in function? How would you grade the improvement on a scale of 0-10?
• Was a specific setting more useful today?
• Was a specific setting more useful during a specific time of the day?
• Did a specific setting cause the symptoms to worsen?

Additionally, patients can write about their own experiences during the treatment, such as mood changes and feelings, which allows the healthcare team to adequately address any other concerns that may be observed during treatment.