SCS Experiences please. Placement / Dermatomes?

[mmglobal]

I recently sent Dr. Whitworth a question about Spinal Cord Stimulators. It's clear that there is a ton that I don't understand about them. I'll post my question and his answer here in the hopes that someone can benefit.

If you have any experience with SCS's, can you post here?

Thanks in advance for the help,

Mark

Originally Posted by Question for Dr. W

I have a client with Charite' at L5-S1 18 months ago with excellent results.

Several months ago, he started having significant foot pain. A local (Utah) pain management gave him a trial SCS that generated very positive results.

His most recent imaging shows potential problems at L4-5, not too bad yet, but enough to give pause and make me wonder if that could be the culprit.

My question is, if SCS in implanted to address leg pain at L5-S1, would positive results come only from issues below the stimulator? With a nerve block, I understand that it is effective only if the source of the pain is below the block. Does the same 'mapping' apply to SCS results?

Originally Posted by Reply from Dr. W

Mark, good to hear from you again. The distribution of pain relief from spinal cord stimulator placement is in the shape of a bell curve. To get the L4 and L5 dermatomes, the stimulation is performed in the thoracic spine at approximately levels T9 and T10. T8 or T11 will partially reduce pain, but not nearly so much as T9 and T10. There is a "sweet spot" that will maximize the pain relief, but this varies from person to person, thus the availability of electrodes with 8 to 16 closely spaced platinum-irridium electrodes that can be independently activated to find the sweet spot. At any given locus of stimulation on the spinal cord (eg. the level that will maximally stimulate the L5 dermatome), there will be some spillover of pain relief and stimulation sensation onto other nearby dermatomes (eg. L3, L4, and S1 for the L5 dermatome maximum stimulation). Hope this helps. Feel free to post this.

Again, any SCS experiences would be greatly appreciated.

Thanks,

Mark

I posted this over on Braintalk and with so much more traffic there, I expect there to be more replies. (Braintalk Thread)

[Jim M2]

I bumping this thread to the top in hopes that someone out there can contribute their SCS experience. I know there are a couple of very bad SCS experiences here at the ispine forum.

My PM doctor wants me to think about SCS. I see him again in early November. At that time I'll decide whether or not to try the trial SCS. I'm kind of pessimistic about this technology. I think a major pain source is my L4-5 disc. I've found nothing to indicate SCS works on discogenic pain. I have many other pain generators in the lumbar and SI region so maybe it would help with those.

Thanks in advance.

[Maria]

the rather stupid question I'm about to ask Jim... but why a spinal cord stimulator vs. a pain pump? I guess when it was explained to me the pain pump is implanted when the amount of pain meds is too much and not quite reaching the pain levels needed or one cannot function on oral pain meds and still needs medicating.

I guess I don't really get if SCS is more of a distraction type of deal than actually dealing with what a pain pump would do or maybe the pain pump is the absolute last resort?

I probably should go back and google all this because obviously I'm rather out of the loop here re SCS.

Good luck whatever anybody tries! Please post experiences for the benefit and edification of others! thanks, Maria

[Jim M2]

Maria,
I don't know the answer to your question, I'm just learning about SCS myself. I take 300 mg of Tramadol/day and 4 g Gabapentin.

I also get the impression that SCS causes a distraction from the pain. I have a Boston Scientific DVD which is a sales job. The one animated example they show is for radicular pain in the legs. That is not my situation.

I was thinking a TENS machine just presents a distraction so I dug out my TENS unit from ten years ago and wore it 3 or 4 hours yesterday. I think it helped although I had it cranked up very high; my back muscles were contracting and pulling me back with each pulse. It gets pretty uncomfortable.

[Jim M2]

Bumping back to the top.

[Maria]

Hey Jim,
I remember I tried a TENS but had to crank it up so high and it didn't really do enough for me. Later somewhere down the road I was given another machine which is a bit stronger to use that actually did help but I can't remember the name of it. When I'm not thinking about it probably I'll be able to remember what it's called and I'll try to get back here and let you know.
Now you can order them on the net for a fairly reasonable price I believe.

[Jim M2]

Hi Maria,

Mine is a "1st Choice Plus" available online at Bodyclock (UK website) or Amazon UK. It is strong enough for me. It is plenty strong enough to feel more like a straightforward electrocution between levels 4 and 5. I had a thread from the electro pad loose and stuck between the pad and my skin one day and it felt like is was burning the surface of the skin.

[mmglobal]

Jim, I'd be interested in seeing the DVD you have... can you mail me a copy or put an ISO file where I can get it?

Thanks,

Mark

[Jim M2]

Hi Mark,

I'd be glad to mail it to you. I'll mail it on Wednesday.

Jim

[Maria]

It actually doesn't feel stronger than a TENS but it goes deeper re the stimulating than the TENS so it's more effective. I still can't think of the what it's called~ not the name but the type of product as it is a step up from a TENS.

Electrocution yeah that's what the TENS felt like when I had it cranked up all the way trying to walk thru Target when I used it. It was a waste for me. I gave mine to a friend who found it useful. It works for some and not for others .. like most things spiney related

[Jim M2]

Wowsa, that's definitely worth a try. Even if it's hundreds of dollars it's a small price to pay compared to the disruption and risk of major surgery.

[Jim M2]

Mark,
My wife dropped the DVD into the mail yesterday.

[mmglobal]

Got it! I'll post when I've had a chance to look at it. If anyone is interested in seeing it, let me know.

Mark

[Jim M2]

The contractor restoring my condo has a SCS. He has a triple lumbar fusion, the hardware has been removed. He has failed back syndrone. Yet he is hanging drywall, installing cabinets, painting, etc. He makes me feel like a wimp. He is a retired marine. I get the impression the VA showers him with pain pills. If I get the chance I'll ask him more about the SCS and put the result in this thread.

[Maria]

Interferential I believe. I'll have to google it and see if I got it right.

[Jim M2]

Yes 'Interferential' produes many results in google. Thanks, Maria, I'll check it out.