For some patients, spinal cord stimulation offers a non-addictive option for pain relief

A lifetime of lifting feed sacks did a number on Rusty Martie’s back. By the time he turned 55, the Monticello business owner and part-time farmer liked to tell people that his body had been breaking down for at least five years.

“I had a sore back every day,” Martie said. “The pain never went away. I’ve been working at the store since I was 18, and we farm about 300 acres on the side. It’s wear and tear. It’s just what happens, I guess.”

As long as Martie kept working, he felt OK. But when he came home and sat down or tried to sleep, his back ached relentlessly. Determined to find a solution for his chronic pain, Martie searched for a therapy that could help.  

“I went to the chiropractor; I did steroid injections, physical therapy,” he said. “None of it helped at all.” Scans revealed the source of Martie’s pain: “I have three bulging discs and one tore one all in a row,” he said.

In 2016, he tried spinal surgery — a diskectomy.  The procedure helped ease his pain for a few months, until Martie returned to work and started lifting heavy sacks for his customers again. The doctor told him he could have an operation to fuse his injured discs together, but Martie feared that that the limited flexibility and weight restrictions that come with the procedure would all but end his ability to work at the store.

“I can’t quit doing what I’m doing,” Martie explained. “There’s nobody else to do the work.”

Martie’s physician eventually prescribed opioid-based pain medication; his back pain was keeping him up at night, and the drugs helped him sleep. But Martie knew that this option, which carried a high risk for addition and was not indicated for long-term use, was not a good solution for treating his chronic pain.

“You don’t want to rely on that any more than you have to,” he said. “You don’t want to get addicted.”  

Martie felt he was running out of options to treat his pain. Then he heard about spinal cord stimulators (SCS), implanted devices similar to pacemakers that deliver electrical impulses to the spinal cord, blocking pain signals from reaching the brain.  

A few of Martie’s customers told him they had SCS implants.

“They really liked it,” he said. “I thought, ‘I’m going to see if I can get in on that.’”

How SCS works

Spinal cord stimulation is an option for people who have tried other methods of treatment for their pain but have not found significant relief, said Peter Stiles M.D., medical director for Tria Orthopedic Pain Clinic. It is considered a last-ditch response to pain management

“A classic example is someone who has a nerve injury in the lower back and their back and leg always hurt no matter what they’ve done,” Stiles said. “They’ve had three surgeries, every class of medication that exists, as well as behavioral modification.”

Using neurostimulation is, Stiles said, “saying there is nothing more we can do as a medical community to fix that pathology. The damage is done. Rather than trying to fix the damage, we are trying to put in an implant that will change the way you feel in your brain.”

The devices, Stiles explained, are in a class of therapy called neurostimulators. When implanted, they deliver low-voltage electricity to the spinal column or peripheral nerves, replacing pain with a tingling sensation known as paresthesia.

There are probably at least two different mechanisms through which neurostimulation works, Stiles said. “The first and better understood mechanism is the gate control theory of pain. That is the idea that our body and nervous system can only pay attention to so much pain at a time and will preferentially pay attention to the strongest one.”

One analogy Stiles like to use is the stubbed toe. “When you stub your toe, what’s the first thing that you do?” he asked. “You grab your toe and rub it. Or if you bang your head on a counter you start rubbing it. You are superseding the pain signal with a sensory signal.” Rubbing makes the injured part feel better, Stiles said: “You are overriding the pain input with sensory input with actual physical touch.”  

An SCS supersedes the pain impulse.

“If you have a nerve injury in your leg you feel a buzzing through your back and your leg,” Stiles said. The technical term for this is paresthesia, he explained: “With SCS, patients feel a paresthesia in the area of pain in the form of a gentle buzzing sensation instead of a searing pain.”

If implanting an electrical device seems like an extreme approach to pain relief, it is, said Tony Yaksh, professor of anesthesiology, and pharmacology at the University of California-San Diego. But concerns over the addictive qualities of opiates, one of the most commonly prescribed form of pain relievers, Yaksh said, has driven research into viable alternatives for pain relief.

“A lot of interest has arisen around developing new analgesics, more powerful ones without addictive properties.”

It is important to remember that spinal cord stimulation reduces pain — but does not cure the pain’s source, Yaksh added. That is why physicians like Stiles consider it a last-resort treatment.

“As a physician, when you have a patient with a disease like cancer or back pain or rheumatoid arthritis, your first aim is to cure the disease,” Yaksh said. “Failing that, you can’t ignore the fact that your patient’s quality of life is severely impacted by their pain state. Palliation of patient’s pain state is a big criteria that follows the inability to completely cure the disease state.”

‘It blocks the pain’

After consulting with his physician, James Parmele, M.D., of iSpine Pain Physicians in Maple Grove, Martie decided to go ahead with SCS. He learned that the therapy wouldn’t repair his spine, but it would make it possible for him to work and live without constant pain. He had Intellis, an SCS developed by Minneapolis-based medical device manufacturer Medtronic, implanted in December 2017.

“It blocks the pain,” Martie said of his implant. It’s not perfect, but it makes his life livable: “I’ve still got pain down my leg. It depends on what I am doing that day. Now it is at least tolerable. I can work a 10-hour day on cement floors lifting feed bags. Then I have to go home and do chores. If I didn’t have this thing in, maybe I’d be incapacitated.”

The device’s battery pack, which Martie describes as “about twice as big as a silver dollar,” was implanted in his lower back, at his waistline. Two electrical leads were implanted on either side of his spinal cord. “You don’t even know the leads are there,” Martie said. He charges the implant for an hour each night. If Martie decided to discontinue SCS treatment, the device could be removed with a simple outpatient surgery.

The amount of electrical impulse self-corrects, depending on Martie activity level, but he also has the option to adjust the levels himself. Fall is a busy time of year on the farm and in the shop, so Martie can turn the levels up high when needed.

“I can go from 0-25,” he said. “Right now I’m at 6.8, so I’ve still got a long ways to go.”

A viable alternative?

Is SCS a good option for pain sufferers and physicians seeking to avoid overuse of addictive medications?

Matt Thomas, Medtronic general manager and vice president of pain stimulation and early intervention, said that he believes the opioid addiction crisis further emphasizes the importance of developing other options for pain sufferers. Spinal cord stimulation could present an option that reduces reliance on opioid-based analgesics.

Lexi Reed Holtum, executive director of the Steve Rummler Hope Network, a nonprofit dedicated to creating solutions to chronic pain and opioid addiction, said she wishes her fiancé, the organization’s namesake, would have known about options like SCS when he was seeking help from a physician for his chronic pain.

“The alternatives should’ve been there from the get-go,” Holtum said. “What happened for Steve was that he was treated with opioids first. Years and years into his being addicted to opioids, they finally tried to treat him for his chronic pain with other methods. That was a few months before he died.”

Stiles, who also serves as vice chair of the Steve Rummler Hope Network board of directors, said he thinks SCS is a good option for some patients, but not all. It is important to assess the whole patient first, to exhaust other options of pain relief before turning to this option: “Right now it is generally accepted as a treatment of last resort.”

And SCS does not always completely replace the use of opiates for all patients, Stiles cautioned.

“I have never put a SCS in someone who hasn’t been on opiates,” he said. He considers the treatment part of a comprehensive “toolkit” for treating pain: “For many people, this therapy is not a way to completely avoid opioids. It is a strategy. But I have tapered people off opioids with the assistance of this device. And for some people it can produce life-saving outcomes.”

Martie would be the first to say that his SCS hasn’t completely removed pain from his life, but it has made his life a lot more livable. He says his chronic back pain has moved from a rating of 8 out of 10 to a 4, and he can manage it without the use of drugs.

Looking back on the past, Martie now wishes he would’ve taken it easier on his body before he permanently damaged his spine. He’s pleased with his surgery and would “do it again in a minute,” but he knows his life would be easier if he hadn’t lifted and tossed all those bags in the first place.

“When you’re young you’ve got a strong back and weak mind,” Martie said. “You don’t care. Now I tell the young kids to be careful, to take it easy: You only get one back. It’s the only one you’ve got.”