Spinal cord stimulation

The waiting times are variable. It may therefore be necessary to call our administration team in order to have a better understanding of the waiting times 0113 3925606.

A discussion involving all the relevant team disciplines about the appropriateness of a spinal cord stimulator for you, any arising concerns from the team, the type of system to be considered and the decision to have a trial or full implant.

When a referral for an SCS psychology assessment is made, this forms an integral part of the pathway for considering whether to proceed with an SCS trial/full implantation, so it is important that you attend your assessment. Patients often report that the discussions are useful. If you cannot attend the arranged appointment, please let the pain psychology service know, with as much notice as possible, so that your appointment can be rescheduled. Please be aware that if you choose not to have the assessment, this will usually stop the SCS pathway and further consideration for this will not continue until you feel able to engage in the assessment. Please be reassured that the psychology team will do their best to make you feel comfortable and supported during the assessment. If you have any concerns, please let us know and we will do our best to support you.

You will receive a telephone call to confirm the date of your planned procedure. If this is not convenient then alternative dates can be explored. A letter of confirmation will be sent out to you in the post.

The appointment may include the following: routine bloods taken, height and weight measurement, COVID swabs taken and possibly a urine test and ECG. You will also be given MRSA prophylaxis treatment. This consists of a wash and a nasal ointment to use prior to the procedure. Please follow the instructions closely. The department will typically ask you to set aside approximately 60-90 minutes for this appointment if it’s necessary. It may be possible to conduct this appointment over the telephone but if this is the case you will be advised.

This is to confirm that you wish to proceed and discuss any outstanding questions you may have with your Consultant. You will sign the consent form, having been fully informed and agreeing to the procedure.

This will have been discussed already with your Consultant or the Pain Nurse you have spoken with. If you have stopped taking Warfarin, Clopidogrel or Aspirin prior to surgery, please follow advice from the Team as to when to restart this. Do not make any other changes to your pain medication without advice from either the Pain Nurses or your GP. Unless you have been told otherwise, you should continue to take your regular medication, especially if you have diabetes.

Depending on the ease of insertion, the time for a trial is normally about 30 to 60 minutes and 60 to 120 minutes for a full implant, although sometimes it can be significantly longer. Everyone is different!

Yes you will, although the Anaesthetist may provide some sedation which can make you feel sleepy. If we need to check the lead placement during the procedure, we need you to be awake and able to answer questions.

The procedure is performed using local anaesthetic and sedation so it should not be too painful but the local anaesthetic does “sting” when it is first injected. During certain points of the procedure, you may feel pressure and tugging but this should not be painful and you can ask for more painkillers or sedation if needed. After the procedure, there will be pain and discomfort over the surgical wounds where the electrode and internal battery are sited immediately after the local anaesthetic starts to wear off. This pain can last several weeks as with any surgery.

Generally, the device is switched on immediately. The company representative will guide you through the programs and the equipment immediately after the operation. Please ensure that you are happy that you know how to use the device before leaving, asking for help if necessary. This is particularly important if you are having a trial because the trial can only last a limited time for safety reasons.

Showering and bathing is to be avoided throughout the whole trial period. A stripped wash is fine, but it is very important that your lead, external battery and dressings do not get wet.

There should be no bathing throughout the entire period of the trial, due to the external lead and battery.

This is variable. Most patients get some relief immediately, although with varying degrees.

This is an individual decision and depends on many factors, including how the pain is, how quickly you recover from the procedure, the type of work you do, whether you work in a manual or physical job or where you need to sit for long periods e.g. at a computer. We can only guide patients, along with your GP. Your employer may need to make changes temporarily/permanently to try to help and support you in the workplace. 

Gentle mobilisation, such as walking can be performed during the trial period, but avoid exercise due to the risk of lead movement.

You can not go swimming during a trial.

This again is down to the individual. During the trial this may be uncomfortable because of the external battery and the worry of the leads being pulled out.

Yes, the leads are only anchored to the skin and not to the spine like a fully implanted spinal cord stimulator, this make them vulnerable to movement. You may notice that the lead is hanging out more or has fully come out of the skin. If this happens contact the PAIN team.

No, you can not drive during a trial of SCS, but you can be a passenger in a car.

After implantation of a full system including a battery, we ask you to either make an appointment with your GP at 7 to 10 days post insertion to have a wound check and remove any sutures that may be in place, or have a video appointment with a PAIN team clinical nurse specialist. Any signs of infection or any problems noted should be reported to the PAIN Team as soon as possible and follow the advice of your GP.

With a full implant, unless you have been advised otherwise, you may remove your wound dressing and shower after three days. Please do not “scrub” or actively wash your wounds.

Following a full implant, patients are advised there is no bathing or swimming for a period of 6 to 8 weeks. We also advise against stretching or bending post-operatively in order to allow the internal lead to settle into place 

This is variable. Most patients get some relief immediately, although with varying degrees. There will be significant post-operative pain at the implanted battery site which often persists for a considerable amount of time.

This is an individual decision and depends on many factors, including how the pain is, how quickly you recover from the procedure, the type of work you do, whether you work in a manual or physical job or whether you need to sit for long periods e.g. at a computer. We can only guide patients, along with your GP. Your employer may need to make changes temporarily/permanently to try to help and support you in the workplace.

Taking into account the lifestyle changes/restrictions we place upon you post-operatively, we would expect you to build up your exercise slowly when you feel able. You may find walking much easier or even feel much more motivated to do things around the house and garden because you may be sleeping better. As will have already been discussed in the nurse information session, contact sports or bungee jumping are not advisable! Following your 3 and 6 month checks at the hospital, you may be at a point where you can take up activities that you previously enjoyed such as cycling, running and golf. This would be a joint decision on when and how to proceed. Generally we would hope that by 6 months things would be well enough to move forward.

Once your sutures have been removed, the wounds have healed and the lifestyle restrictions have been lifted at 6-8 weeks, swimming should be fine. It may be a good thing to start off walking in the water initially to build up your core stability, obviously taking care not to over exert yourself!

This again is down to the individual and may be uncomfortable at first due to pain from the wound sites.

No, you do not need to. It is advisable to check regularly that the device is switched on by using the handset. Remember to take both the remote and the charger if applicable and any cables necessary with you if you travel away from home at any point, no matter how long you plan to be away, as you may decide to stay longer than planned!

There is always the chance that the internal leads can be displaced maybe following a slip, trip or fall (or even just bad luck!) or that you have perhaps not followed the initial guidelines on post-operative restrictions. Generally, if the lead has moved or broken, you would experience the return of your original pain, despite the device being turned on. If the movement has only been very slight, we can sometimes remedy this with reprogramming. If the movement has been significant, it could mean a whole new lead and/or a new battery depending on the extent of the damage. In this instance, the whole process needs to be repeated!

This is the key advice:

• You can be a passenger in a car immediately following insertion of a spinal cord stimulator and during a trial.
• Do not drive for at least 4 weeks following insertion of a fully implanted spinal cord stimulator.
• After 4 weeks you may drive if you feel able to perform an emergency stop, make emergency maneuverers and safely operate all necessary controls of your car.
• Please seek advice from your insurer prior to driving.
• Do not drive with a paraesthesia (“tingling”) based spinal cord stimulator whilst it is turned on.