Exploring Spinal Cord Stimulation: Innovative Pain Relief Without Medication

Welcome back to the Kentucky Pain Reversal Show! In today’s episode, we dive into one of the most innovative and medication-free advances in pain management: spinal cord stimulation. Building on our previous conversation about intrathecal pain pumps, we sit down with Dr. Ajith Nair to explore how spinal cord stimulators offer hope and relief for patients struggling with chronic pain. Discover how this technology interrupts pain signals, the conditions it’s best suited for, and how it stacks up against medications, injections, and surgery. Plus, Dr. Nair shares insights on the trial process, patient experiences, and the ethical landscape of pain treatment in America. If you or a loved one are seeking alternatives to pills and procedures, this episode could offer the answers you’ve been searching for.

00:00 How spinal cord stimulators work

05:37 Nerve stimulation for pain relief

08:22 Spinal cord stimulation benefits

12:23 Considering alternative pain management options

14:30 Spinal cord stimulator function

17:21 Addressing phantom limb pain

22:09 Managing Chronic Pain with Stimulators

25:47 Insurance influence on pain treatments

29:54 Challenges in Pain Management Clinics

31:12 Improving patients' quality of life

Podcast Website - https://thekentuckypainreversal.com/

Dr. Ajith Nair Clinic - https://kentuckianapainspecialists.com/

Media Partner - https://tophealth.care/

Transcript

SPEAKER_01 0:00

I've had back problems, and I know what it is to feel really bogged down, feel like there's no point in doing certain things. With proper treatment of pain, it is giving people a new release on life. Yesterday I implanted two patients with a pain pump. One lady had her entire low back fused, and she's 75. This poor lady for the last 30 years, her quality of life must have been so bad. We implanted her yesterday, we started her pump today, and she's already saying that her pain's much better. She's able to stand straighter.

SPEAKER_00 0:57

In our last episode, Dr. Nyer introduced one of the most advanced tools in pain care, the intrathecal pain pump, and how it delivers medication with incredible precision and control. Today we're exploring a different approach, one that doesn't rely on medication at all. It's called spinal cord stimulation, and instead of adding something to the body, it works by changing how pain signals are communicated with the nervous system. So let's dive in. Dr. Nyer, in the last episode, we talked about pain pumps, which deliver medication more precisely. Today we're talking about something very different: spinal cord stimulation. Tell us what this is in simple terms.

SPEAKER_01 1:38

Well, in simple terms, the spinal cord stimulator provides electrical stimulation to interrupt the pain pathways. So, for example, if let's say I have uh severe pain coming from my left toe, well, the impulses, the painful impulses, will start from the toe, they will travel through the peripheral nerves in the body, and then it will reach the spinal cord. Then from the spinal cord, it will continue to ascend until it is perceived in the brain. Well, the spinal cord stimulator will intercept or divert away these impulses from continuing to ascend through the spinal cord and reaching the brain. So it interrupts those impulses. So the pain now is not perceived as pain anymore. It is perceived as more of a vibratory or a tingling light sensation.

SPEAKER_00 2:47

Interesting. Okay, so it's almost like it makes me think of a football game or a basketball game. You're throwing a pass and somebody else catches it. Although that usually, if you're for the team that's throwing the ball, it's not such a good thing. But perhaps perhaps a way to think about that. Um, when people hear spinal cord stimulation, it can sound a little intimidating, right? That's a very delicate and important uh part of the human body. Can it you explain more about what's actually happening in the body when that therapy is used?

SPEAKER_01 3:21

Absolutely. So now the spinal cord stimulator um is placed in the spine into the epidural space. So the epidural space is a space that's present uh in the spinal canal, it is right behind the spinal cord. So, yes, to some extent, it can be challenging for providers or for the lay person who's thinking about a spinal cord stimulator, it would be like having something close to the spinal cord. Now, in reality, it is close to the spinal cord, but for practitioners that have done it uh for a long period of time, it is a very safe procedure. It is done also with the help of X-ray guidance in the form of either a fluoroscopy or uh using ultrasound.

SPEAKER_00 4:20

All right, and what is fluoroscopy?

SPEAKER_01 4:22

Fluoroscopy is this machine that you see that's behind me. It's essentially a portable X-ray machine that will allow me to see some of the structures where I'm placing a needle into.

SPEAKER_00 4:38

That's incredible. Dr. Naira, one of my favorite things about your practice and about this show is you always have a visual representation or a prop to show us exactly how things work. So that's incredible that it's sitting right behind you there.

SPEAKER_01 4:54

Well, I think it's very, very important that patients understand how a procedure is done because at the bare minimum, the patient should be aware of what's being done so that they can put into perspective how the procedure can help them. And it actually improves the healing process.

SPEAKER_00 5:14

Absolutely. And you are so wonderful at that. Education really is at the crux and the forefront of your practice, besides um tremendous results. Um, okay, so an interesting idea here is that you know, instead of adding medication, right? We talked about pills in past episodes or even the pain pump, right? Instead of adding something to take away the pain, we're changing how the pain signals are actually transmitted. So unpack that a little bit more for us.

SPEAKER_01 5:45

Very good. So now, as you mentioned earlier on, with an intrathecal pump, we are delivering medication, a narcotic, and we are using that narcotic to reduce pain. Here we're using electrical impulses to be the pain-relieving factor. So very often we can see patients who have phantom limb pain or sciatica or crush injuries, and more commonly, there's a condition called complex regional pain syndrome, where this therapy works very effectively, mainly used for pain that is originating from the limbs, like the lower extremities or the upper extremities. And the electrodes are placed in the epidural space, and depending on where the pain is, the position of those electrodes would differ. Now, there is another variation of nerve stimulation that is called peripheral nerve stimulation. I'd like to contrast that with spinal cord stimulation because in the spinal cord stimulation uh system, you are actually stimulating a part of the spinal cord. However, with peripheral nerve stimulators, you are stimulating the actual offending nerve. So, for example, to be more specific, let's say if a patient has knee pain, there are specific nerves that conduct the nerve, the pain uh impulses. We are able to identify those nerves and then place a small electrode in the vicinity of that nerve, and then there will be an external power source. So that would be a peripheral nerve stimulator. If it was a spinal cord stimulator, the batteries would be implanted. It would be placed under the skin. So there are pros and cons for both. Um, with a spinal cord stimulator, the batteries are completely implanted, so there's nothing on the outside. With a peripheral nerve stimulator, um, the the electrodes are placed under the skin, but the power source is outside. So you can wear like a knee brace, which will contain the battery source, which will allow the stimulation of that electrode, thereby reducing the pain at the nerve level.

SPEAKER_00 8:20

Got it. Okay, so let's talk more about the types of patients or the types of conditions that are best suited for the spinal cord stimulation treatment.

SPEAKER_01 8:31

Now, um, I mentioned some of the indications, such as um sciatica. Um you can also develop scar tissue after having multiple surgeries, which will cause you to have leg pain and back pain. You could have crush injuries of the extremities, um, diabetic neuropathy. I have had very good treatment uh or very good results from uh spinal cord stimulation for diabetic neuropathy. In fact, one of my first patients back about 25 years ago, uh, we had placed a spinal cord stimulator for uh pins and needle sensation in both feet, and the patient literally uh went from 10 out of 10 pain to 1 out of 10. So it's a very, very useful uh tool. It doesn't involve a drug, um, and you can turn the generator on and off depending on how bad the pain is at any time of the day.

SPEAKER_00 9:37

That sounds like an incredible solution and treatment if you're one of the patients who has a condition that it would help to uh serve and heal. So many people though too worry about committing to something permanent. Um, what does the evaluation and trial process look like before someone gets a permanent device or is there a trial?

SPEAKER_01 10:00

Uh absolutely. Just like the pain pump, a spinal cord stimulator or even a peripheral nerve stimulator involves a trial. So the trial would be pretty much the same process of placement of the electrode, but this time it's not implanted under the skin. So the electrode will come out of the skin, but the electrode is put in place for only about one to two days. And then in that one to two days, we would be able to assess whether the stimulation would help the patient. Once we determine that, we can remove the electrode and then get the patient back on a different day to have the entire system implanted. So the trial would be the, you know, it would be the uh the test to see whether this works or not.

SPEAKER_00 10:56

Interesting. Okay, so how does spinal cord stimulation compare to traditional treatments like repeated injections or long-term medications or pills or additional surgeries? What's the difference?

SPEAKER_01 11:11

Now, let's start with the additional surgeries. There are so many documented cases and uh review articles that suggest that spinal cord stimulator treatment for sciatica or any type of sciatic pain due to a disc may have better long-term treatment results with a spinal cord stimulator as opposed to having back surgery. Now, there are situations where patients end up having back surgery and they develop scar tissue. And once you develop scar tissue, um getting rid of that sciatica becomes very, very difficult. So, this is another example of where a spinal cord stimulator can step in, because it will address not only the sciatica pain, but also it would give some relief to the back pain also. So that was surgery. As far as uh repeated injections are concerned, one has to weigh the pros and cons. So, for example, if I had a patient who had sciatica from a disc herniation and they received a series of epidurals, and the patient says, Well, Doctor, my pain is about 80% better. And if they come back, let's say a year later with the same complaints, I would at that point still consider another series of epidurals. However, if the pain relief only lasts for about a few weeks, then I don't, you know, I really don't advocate for my patients to have more injections because there are fears about the accumulation of steroids, which can also lead to osteoporosis. So in these types of situations, if the patient is a candidate for a spinal cord stimulator or a peripheral nerve stimulator, I would suggest that as opposed to more injections. And of course, we talked about medications. I can't tell you how many thousands of patients that I've seen who suffer from chronic pain, uh, who have been prescribed pain pills for decades and still complaining about pain and rating it at about nine out of ten. So doing the same thing repeatedly, expecting a different result, is truly the definition of insanity. So I always feel that um if I see a patient who's been taking pain pills over and over again with very limited or not really much results, I would suggest for things like a spalcoard stimulator or a pain pump. Because here, these types of interventions like a pump or a stimulator, the the benefits outweigh the risks.

SPEAKER_00 14:09

Absolutely. And I love that you um speak to and champion so many different options to make sure everyone gets the best results and the best really quality of life on the other side of treatment. Um, so that's a great way to segue into our next question. What does the day-to-day look like for a patient after a successful spinal cord or peripheral nerve stimulation? What changes for them?

SPEAKER_01 14:37

Now, when a patient gets a spinal cord stimulator implant, and let's just say it is for a condition like phantom limb pain. Um the the phantom limb pain may not necessarily be present throughout the day. Some patients may not have the pain at night, or some patients may have more pain when they're active. So the good thing about both of these devices, the spinal birth stimulator or the peripheral nerve stimulator, is that you have with you a programmer, and the programmer will allow you to turn the machine on, turn it off, increase the stimulation strength, or change the pattern of the stimulation impulses. So it's very versatile. So let's say the patient knows that a certain type of activity is going to provoke more pain, they could actually dial up the stimulation pattern. Or if there's a time when the patient doesn't need that much of pain relief, then they can dial it down or turn it off. So it's really up to the patient, and it's really patient controlled.

SPEAKER_00 15:56

That is tremendous. Um, I have a question because I have a parent who actually is in a lower leg amputee and she had a lot of phantom pain uh after the amputation. Now, is that something where you know it it starts off really intense and then as time goes on it dwindles and and the pain isn't so uh present, or is it something that you see is constant?

SPEAKER_01 16:25

Well, quantum limb pain comes in many forms. Now, usually when an amputation is done, obviously a nerve has to be severed. Now, when the nerve gets severed, there is a part of our brain where our entire body is mapped out. So even though the limb may not be present, the brain still interprets it as being present, and it takes some time for the brain to realize that the limb is no longer there. In fact, there's a term for it, it's called telescoping, where eventually the brain will accommodate to the fact that that limb is no longer there. However, some patients will develop this pain that is in the place of the missing appendage. That is one form of phantom limb pain. Another form of pain would be the pain that originates from the severed nerve itself. And usually that's termed as stump pain. Now, stump pain, there are many more things you could do. You could do nerve blocks to help with that. But both phantom limb and stump pain respond very well to a spinal cord stimulator. I hope that shed a little bit more light on uh how to address phantom limb pain. I I whenever I see my patients with phantom limb initially, I always suggest doing the more conservative treatments, which would be things like physical therapy, mirror therapy. Um and once those things have either stopped working or they they don't really give the patient much relief, then I would suggest a spinal cord stimulator trial.

SPEAKER_00 18:26

No, that's so interesting. Thanks for telling us a little bit more about phantom uh limb pain. Um, you know, it's probably more common than we think. So I'm excited that our listeners get uh a little bit more info um on that. So thank you. Um, Dr. Nyer, anything else you want to add before we wrap up today?

SPEAKER_01 18:48

Well, 15 years ago, I used to place spinal cord stimulator electrodes for patients that have facial pain. Um, even though this was an off-label indication, we were able to treat many patients with uh with uh severe chronic headaches, migraine headaches, which really responded well to um the spinal cord stimulator. Of course, in the last five years, peripheral nerve stimulators uh have become available. So these types of nerves in the head and neck area can be treated with peripheral nerve stimulators today. So very versatile, doesn't involve a drug, it is electrical impulses. And you know, there are some patients that don't want to take medications. So for those patients who have limb-related pain, peripheral nerve pain, they don't want to take any drugs, they don't want to take things like gabapentin or or uh ametryptaline or hydrocodones or the percocytes, then using electrical and electrical impulses to control pain would be the best option to consider.

SPEAKER_00 20:07

Dr. Nyer, how do you decide between whether a patient gets a pain pump or spinal cord stimulation and what factors guide that decision for you?

SPEAKER_01 20:18

You know, that is a very, very important and good question. Now, the unfortunate reality that we face in America is that for most chronic pain conditions, doctors prescribe a pill. And very often it is a narcotic. And if that prescription has been given over and over again over months, not only do the patients develop a tolerance, but they become used to it. They become used to having their pain controlled, or they think it's controlled with pain pills. So if these same patients, if they also would have benefited from a spinal cord stimulator, then what I feel happens is that you put a spinal cord stimulator in in then to address the pain, but the pain, the but the patient is still on pain pills. Now you've actually done two things. You've spent a whole bunch of money on the spinal cord stimulator, and you're still spending money on pain medication. Now, when I say you're spending money, there is uh expenditure or healthcare dollars are spent on it. That's what I mean. And I that doesn't really sit well with me, because if these patients who had these conditions could have been offered things like a spile cord stimulator right from the beginning of their pain journey, then that would have been sufficient to control their pain and not require pain pills. But in those situations where patients have now been taking hydrocodone 180 pills every month for years on end, and they come to see me, at that point, I would not be suggesting a spinal cord stimulator, but I'd be suggesting a pain pump. Now, there is a way, there is a way to finesse between stimulators and pulse. For instance, if you had a patient who has sciatica, they're taking their pain pills, um, maybe a hydrocodone tens, three or four times a day, then there is a way that we can maybe start gently weaning them off the pain pills. They don't have to completely come off the pills, but we can institute a spinal cord stimulator trial at that point to see if their pain gets better. Because if their pain does get better at a lower dose of pain medication, you know for certain it's the stimulator that's helping them with the pain. And so it would be much easier for the patient to get a stimulator and completely wean off the pain medications. So I hope that kind of gave you a better idea as to how I make a clinical decision as to whether to go with a spinal cord stimulator or with a pain pump.

SPEAKER_00 23:29

Absolutely. That seems silly to be doing two things at once instead of trying to figure out which one is act actually more effective. Um, and you know, we like you said, we know uh which one uh would be. Um thank you for joining us for today's conversation. This conversation really highlights a powerful shift in how we think about pain, not just something to suppress, but something that we can actually interrupt and reframe within the nervous system. For patients who have struggled for years through medications, procedures, and even surgery, options like the spinal cord stimulation represent a different kind of possibility. So our motto here at the Kentucky Pain Reversal Show lower the pills, lower the surgeries, and stop the pain. Thank you, Dr. Nyer. We will see you next time.

SPEAKER_01 24:21

Thank you so much. Have a good day.