Spinal cord stimulator implant: the trial, the operation, risks and recovery

Spinal cord stimulation is generally considered for chronic neuropathic pain, meaning pain driven by damaged or irritated nerves, when other measures have not worked. Leeds names medication, physiotherapy and injections as treatments that will usually have been tried first. Your pain team will decide whether your pattern of pain suits it.

It is not a cure, and it works on the sensation of pain rather than on the cause. Leeds quantifies this: the benefit is measured as an average 50% reduction in pain, and it says there is a 20 to 40% chance that the stimulator will not work for you. That is why the trial exists, so that you and the team can see before you commit to an implant.

It is generally not the right step while basic treatments are still untried, or when pain is mainly driven by something that could be corrected more simply. Ask your team why they think your pain is the sort that stimulation addresses.

Alternatives include nerve-pain medicines, physiotherapy and graded activity, psychological approaches to pain, and image-guided injections such as nerve root blocks. A pain service often goes through these in turn, and a stimulator is considered after they have not given enough relief.

Long-term pain involves mood, sleep and activity as well as the nerve signal, so a stimulator is normally discussed within a specialist pain service. If one is suggested, ask what the other remaining options would be and what they would realistically offer.

North Bristol describes the trial in steps. You lie face down and, under local anaesthetic, a needle is placed in the back and a fine wire is threaded through it to lie over the spinal cord, with its position confirmed on X-ray. The wire is brought out through the skin and secured to the back, then connected to a temporary battery and a remote control that you take home.

Leeds describes the same stage with local anaesthetic and light sedation, with the lead exit point secured under a dressing and an external power pack worn on a belt or under a dressing for 10 to 14 days. At the end you return to clinic, where the lead is removed; Leeds says this is painless and needs no anaesthetic. Dudley describes a different pattern, with a trial of about a week during which you stay in hospital.

During the trial you are asked to carry on with the activities that usually make the pain worse and to judge how much the stimulation helps. Success in the trial is what decides whether you go forward to a permanent implant.

North Bristol says the permanent system is implanted under general anaesthetic or sedation with local anaesthetic. A small cut in the back allows the electrode to be placed against the spinal cord. A thin connecting wire runs under the skin to a second cut, in the buttock or abdomen, where the battery is placed. The system is programmed afterwards, and sutures or clips are removed 7 to 10 days later.

Leeds says the battery can be placed on the chest wall or just above the buttocks and that the work is typically day-case surgery. Dudley describes a two-stage pathway with the full implant a week after the trial, done under general anaesthetic, with the pulse generator placed in an abdominal pocket. Details therefore differ between hospitals, and your own team will explain their approach.

You control the device with a hand-held programmer, which lets you change the strength of the stimulation within the limits your team sets.

North Bristol puts infection at approximately 5% of cases and says it may need removal of the system. It also lists bleeding, headache, allergic reaction, stimulation in the wrong area, intermittent stimulation, failure to relieve pain or an increase in pain. Nerve damage is described as rare and paralysis as very rare.

Leeds lists bleeding, infection, paralysis, spinal fluid leak, meningitis, nerve damage and the need for revision surgery as rare serious risks. Dudley puts headache, cannula problems, infection and electrode displacement among the frequent problems and spinal cord injury, meningitis and haematoma among the rare ones. Ask your own team for the figures from their service.

North Bristol warns that you should seek advice before any MRI scan, because it can cause harm to you and to the generator. Tell every clinician you see, including physiotherapists, that you have a stimulator.

Both North Bristol and Leeds set restrictions for several weeks after the implant: no raising the arms above the head, no bending, twisting or heavy lifting, and limits on prolonged sitting. North Bristol gives four to six weeks and Leeds six to eight, and Leeds recommends log-rolling to change position in bed. Dudley expects discomfort for up to six weeks and advises keeping a good posture.

For driving, North Bristol advises avoiding it for at least two weeks and Leeds for at least four, plus during the trial, and neither allows driving with the stimulator switched on in a tingling programme. Leeds says first reviews may be by telephone or video, with face-to-face reprogramming starting after about six weeks once the wounds have healed.

Keep wounds clean and dry, and watch for leakage, redness, swelling or a raised temperature, as North Bristol advises.

North Bristol lists increasing severe back or neck pain, new pain, weakness or numbness in the limbs and fever or flu-like symptoms as reasons for emergency care. Leeds adds a high temperature with neck stiffness and headache, difficulty passing urine, faecal incontinence and heavy wound drainage, and asks you to attend your nearest A&E and bring the information leaflet.

For redness, pus or swelling at a wound, contact your pain nurses promptly. For anything severe, call 999 or go to A&E, and use NHS 111 when you are unsure.

• What counts as a successful trial in this unit, and how will I record it?

• Which device is proposed, and does it need charging?

• What would stopping or removing it involve?

• How will MRI scans or other treatments be handled in future?

• Who do I contact, and how quickly, if the wound looks wrong?

Access on the NHS is through a specialist pain service and depends on local commissioning, so waiting times and thresholds vary. Privately you may be offered it earlier, but ask what is covered if the trial fails, if the device needs revision or if you need long-term reprogramming, because the device needs follow-up for as long as you have it.