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

Rusty Martie
Courtesy of Rusty Martie
Rusty Martie on spinal cord stimulation: "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."

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.

Dr. Peter Stiles

Dr. Peter Stiles

“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.

Matt Thomas
Matt Thomas
“It is critical that we have good alternatives to opioid use,” Thomas said. “Device-driven options that supplement or reduce use of these medications are critically important.”

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.”

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Comments (7)

  1. Submitted by Freda Lovell on 10/08/2018 - 06:03 pm.

    However, they do NOT work for everyone. If you have nerve pain, I found during the trials that my nerve pain was worse! That being said, please pay close attention to your trail and DO NOT be PRESSURED by your Doctor or the REP from the Device Company to go ahead and get one anyway!! The can make adjustments and they did try to make adjustments to mine, but still no improvements. I had scar tissue from previous SCS that had to be removed due to a BAD battery that the neurosurgeon felt was ready to explode inside my body and he ordered a STAT removal of the SCS. Since that one the batteries have been improved, but beware these medical devices are NOT perfect. Metrontic alone has many class action law suits for many of it’s devices on the books. They make Trillions of dollars and if one device or a handful of devices go bad it’s no big deal to them, but as the patient it can be a BIG DEAL to YOU!!

  2. Submitted by John Osbon on 10/08/2018 - 10:49 pm.

    For anyone considering getting an SCS keep in mind that this device does not work for everyone. I’m one of the unfortunate few for whom it didn’t. I worked with the technicians to try many different program settings and levels to no avail. I did feel pain relief for the first six to eight months after the implant but after that it was ineffective at controlling any of my lower back or leg pain. In addition where the generator was implanted started to become inflamed and the generator itself started to become encapsulated. I could not sit up straight because of the pressure that would be put on the area where the generator was implanted. I went in thinking and hoping for the best but now I’m back where I started, having to take opiates just to get out of bed some days. I hate this, this is not a life to live and I wouldn’t wish it on anyone, but it’s the cards I’ve been dealt so I try to make the best of it. What it all boils down to is do your research throughly before you decide to get an SCS implanted. Ask lots of questions, see if you can get in touch with other patients that have been through it and not just the ones who have been helped with the SCS. I wish you luck and hopefully your experience will turn out much different than mine.

    • Submitted by kimberly erickson on 10/09/2018 - 10:33 am.

      I have a Boston Scientific and at first few months it somewhat helped, but now after 3 yrs it’s more of a pain than help I am getting a pump installed they want me to keep the SCS in but want to change it to medtronic I don’t know I need to continue praying to My Lord for an answer cuz I am sooo tried of dealing with this pain and the lack of meds they can give me, this SUCKS being in pain ALL the time please pray for me ?

  3. Submitted by Melissa Rice on 10/09/2018 - 02:12 am.

    Im happy that this works for some people but it didnt work for me …im 39 year old female who suffers with chronic pain .i have gout .3 hernaited disc in lower back ..sever ra .i also have a blood clot disorder . i have had a major heart attack when i was 35 .and i have had open heart surgery ..i have graves disease so that’s two autoimmune diseases I have i have a ruff life .i have tried everything i could before i was put on pain meds .this is the only thing that has worked for me ..and they say its no good for long term well im here to tell u that that is not true. I have been on pain meds for 20 years and they help me get around . ..people like me who need them are being punished because of false information people put out there .yeah i get some people over dose and die but thats not my fault . d

  4. Submitted by Melissa Rice on 10/09/2018 - 02:15 am.

    Part 2 to my comment …i am all for finding something that helps .but in my case i have not found anything. Other than my meds .each month i am being cut back my fear is i. Will get to that point that i cant handle the pain .. I would rather die ..thats how bad the pain can get .

  5. Submitted by marlayna miller on 10/09/2018 - 02:46 pm.

    I too have scs I have had for about 6 months now. It had only worked for my right leg and not my left leg and somehow after about month to they discovered that a spinal cord stimulator had become bent. In this they discovered probably is the reason why I am not getting full coverage for both legs. I have had 4 back surgeries total now. I’m in chronic pain and I think it works okay the Scs. But I believe everyone’s different do I wish I would have not got it I don’t know but it helps about 50% in the one leg and in the other it doesn’t do anything and of course it doesn’t help my lower back whatsoever. the gentleman story was very nice and I wish mine would have worked out the same way has did. I wish everyone well that made comments because I know chronic pain is a terrible thing to go through on a daily basis.

  6. Submitted by Willis Fraley on 10/09/2018 - 05:17 pm.

    I have Stage 3 Reflex Symphathetic dystrophy, I had a spinal chord stim put in 20 years ago and it failed after 1 yr, body adapts to it. They put me on MS Contin I worked as a Physical Therapist in the VA Medical Center in my home town until they made me retire. Now the VA is cutting everyone off of opioids, no exams, treatments, just a dang rule, RSD is rare in males and it goes bi- lateral. I have had 5 biers blocks, 10 lumbar punctures, epidural, Surgical Sympathetictomy and a spinal cord stim implant, All failed in time, Meds was the last resort and now I don’t have it. Nothing else offered as RSD has no cure, so what do I do now, Smoke POT, what a option

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