When traditional methods fail, spinal cord treatment acts like a pacemaker for pain

Record-Journal
By Jeffery Kurz

MERIDEN — Richard Hunt has been in pain since a 1991 on-the-job accident. Hunt, who was a cable-splicing technician for the Southern New England Telephone Co., has undergone three back surgeries and a spinal fusion. He describes the burning pain as considerable and constant, running down his lower back and through the legs to his feet.
In August, the 59-year-old Portland resident underwent a six-day trial with spinal cord stimulation. At the end of the trial period he didn’t want to give the equipment back.
“I could sleep,” he said. “It really does help.”
Now Hunt is looking forward to a more permanent arrangement with the technique.
There’s no date set for the surgery, at MidState Medical Center’s Spine and Pain Institute, but as far as he’s concerned it can’t come soon enough.
Spinal cord stimulation is a way of adjusting the pain signal sent along the spinal cord to the brain, altering t! he pain to what is typically described as a tingling sensation. The technique involves inserting electrodes at strategic parts of the spine, the location determined by the area of pain.
Hunt’s trial surgery was performed by Dr.
Jonathan Kost, director of the Spine and Pain Institute. In August, the Mid State department added another specialist in the treatment, Dr.Dean Mariano.
The treatment is suitable for those for whom more traditional methods of pain management have failed. A major advantage is that it can avoid the side effects associated with pain medication.
The technique has been used since the late 1960s, Mariano said, but in recent years it has been expanding. It now can be considered for those suffering from diabetic neuropathy or vascular disease, for example. In Europe, it has even wider uses.
The spinal cord is the superhighway through which nerve impulses throughout the body travel to the brain. When it comes to pain, the brain has a sort of ranking system. So if you’re hit over the head with a hammer, the boo-boo on your finger will no longer feel so bad, to offer an extreme example. Spinal cord stimulation is a way of manipulating that system.
The electrodes planted at the spinal cord carry electrical signals from a battery-operated neurotransmitter. The generator contains programs the patient can use to control the signals, like a pacemaker for pain. The size of the device varies by manufacturer, but it’s typically no bigger than a pager.
In the trial period, the device is worn outside the body. If the system works, it’s then surgically implanted, just above the buttocks.
The patient then gets a remote control.
“It’s almost like a try-it-before-you-buy-it routine,” Mariano said.
Most users experience a 50 percent to 80 percent reduction in pain, he said.
There’s rarely any question about whether the method is providing relief.
“Either it’s fantastic or it doesn’t do anything,” Mariano said.
Hunt said it took him a couple of days to get the hang of controlling the device. After that, he was sold.
Instead of pain, he felt “a little electrical tingling,” he said.
“Once you get used to it, you don’t notice it,” Hunt said.
The battery for most neurostimulating devices lasts about nine years. Because the implant is close to the skin, replacing the device is not an extremely intrusive procedure.
Candidates undergo careful examination, including psychological evaluation, to help make sure the technique is suitable, Mariano said. While the procedure is covered under most health insurance plans, including Medicare, it does not come cheaply, though Mariano suggested that after comparing it with the costs of pain medication over many years the cost appears less formidable. Hunt said he has had to battle to get insurance coverage for his procedure.
For certain chronic pain sufferers, it’s one of the best treatment options available, Mariano said.

“I have people who have been in wheelchairs who are walking again,” he said.
“My experience is that it has given people so much back in terms of quality of life.”
Hunt has no doubt.
He described the difference when it came to sleeping, for both him and his wife, during the trial period “like day and night.” “It does work,” he said. “It will be nice to be able to smile once again.”