High Frequency Spine Stimulation for Back Pain: Can This New Technology Help Reduce the Opioid Crisis?
It is estimated by the Centers for Disease Control and Prevention (CDC) that back pain affects one in three Americans, causing its economic impact to be greater than that of heart disease and cancer combined. However, this economic impact pales when compared to the human misery associated with this often, unrelenting pain.
Because so many people suffer from back pain, medical science is constantly investigating treatments. One of these, which has been used for thousands of years by practitioners for the temporary alleviation of pain, is opioids. Unfortunately, the side effects of these drugs – including abuse, addiction, and overdose death – have proven to be worse than the pain for which they were prescribed.
This “opioid crisis” has caused many states, and even the U.S. federal government, to hold hearings about ways to reduce the abuse and deaths associated with overdoses of these prescription drugs. It has also shifted the emphasis of medical science to find alternative ways to treat chronic pain, especially back pain. One promising treatment is electric stimulation of the spinal cord. While this treatment has also been used by spine surgeons for many years, the technology on which it is based has recently improved.
New Research on High-Frequency Spine Stimulation
Research at Washington University in St. Louis has shown that spine stimulation, which uses higher frequency impulses than were previously available, can help to effectively mask back pain. The research reported in “Medical Press” noted, “One opioid-free option available at the Washington University Pain Center at Barnes-Jewish Hospital involves stimulating the spinal cord with very short pulses of electricity. Patients can’t feel the electrical stimulation, yet it often effectively can mask the perception of pain.
“Spinal cord stimulation to relieve pain was introduced many years ago, but older stimulators produce a tingling sensation designed to replace pain with less unpleasant tingling. The newer, high-frequency spinal cord stimulators deliver more energy but without the tingling sensations.”
This research noted that 75 percent of subjects treated with the high-frequency stimulators experienced reductions in pain of at least 50 percent after three months. Some reported a 70 to 80 percent reduction in back pain almost immediately.
A Brief History of Spine Stimulation
“The original spine stimulators were developed in the 1960s,” he said. “However, the technology could not be used in a wide-spread fashion until the 1980s. This was because the pacemaker technology, which, like the spine stimulator, could be implanted and maintain electrical stimulation for a long period of time, improved at this time
“Between the 1980s and 2010, the technology was relatively static. There was a certain recognized range of stimulation frequency that could be delivered to the dorsal column of the spinal cord. If the stimulation was delivered within those parameters, the patient would typically get a reduction of pain, particularly pain in the hips, buttocks, shoulders, some parts of the back, arms and fingers.
“Unfortunately, some patients did not get good pain reduction from this type of stimulation. This could be due to the fact that they might have more pain centered in the neck, at the back of the head or in the lumbar spine area. In some cases, the patients would experience paresthesia with this stimulation, meaning they could feel this stimulation and for many that sensation was disagreeable. It was annoying to some patients, and this made it ineffective in coverage of the pain.
“We now have high-frequency stimulation that cannot be perceived by humans. Thus, when this stimulation is delivered, it still has effects on the nervous system and still interrupts pain delivery from those distal nerves up to the brain, but it is not perceived by the patient. This means the stimulation can cover deeper pathways within the spinal cord leading to better coverage of pain in the neck itself, the thoracic area (where the ribs attach to the spine) and the lumbar (lower back) area of the spine.”
Using Stimulation Instead of Opioids
The fact that this new version of spine stimulator is being used instead of opioids for treatment of back pain is good news for the medical community, which is concerned about their abuse. From a medical standpoint, how does spine stimulation mimic the effect of opioids for the treatment pain?
“Actually, spine stimulation and opioids work differently on pain,” Dr. Kutz said. “Opioids don’t eliminate pain but rather they increase the tolerance of the mind to having pain. Most patients who are taking opioids say things like, ‘I can still tell that I hurt, but I just don’t care.’
“With spinal cord stimulation, there is an actual disruption of that pain signal coming up to the brain.”
Texas Back Institute Has Led the Way on This Procedure
In an article from 2014, Texas Back Institute surgeons Dr. Michael Hisey and Dr. Ralph Rashbaum discussed the older version of this spine stimulator and how important surgeon training was for the implantation of these devices. Texas Back Institute has a rigorous training program for young surgeons to properly implant these stimulators.
“As spinal surgeons, we have had the opportunity to perfect both percutaneous (through the skin) delivery of spinal cord leads (power cords), as well as surgically implanted leads,” Dr. Kutz said. Having the ability to perform the technique in both ways is very helpful for patients because each situation is different. Some patients are better suited to have a percutaneously delivered stimulator lead while other patients are better candidates for surgically implanted leads.
“Dr. Rashbaum has been performing spinal stimulators procedures since the 1980s and has a vast experience in the implantation of these devices. There are a number of other surgeons at Texas Back Institute who also have had a great deal of experience in these procedures.”
Good Candidates for High-Frequency Stimulation
“With the high-frequency stimulation, it opens the procedure to a wider range of patients who would not have previously been good candidates,” Dr. Kutz said. “The possibility of stimulating the spines of patients who have primarily axial (that caused by a degenerated disc, facet joint problems and damage to soft tissues such as muscles, ligaments, and tendons) low back pain or axial neck pain is a new area that we are delving into. Previously, these patients would have only been treated with opioid pain medications or an intrathecal pain pump where opioids are delivered directly into the spinal canal.
“This new technology allows us another opportunity to avoid the use of opioids and their potential side effects and control pain through electrical stimulation.
“Most health insurance and Medicare cover this spinal stimulation and despite this, I believe, it is underutilized in general. This is due to a lack of awareness of the general community and also of the medical community.”
If you have chronic back pain, high-frequency spinal stimulation might be an appropriate alternative to prescription medications. Contact us for an appointment to discuss this option.
To hear the complete interview with Dr. Kutz, click on SpineTalk.