Spinal cord stimulators and spinal pumps for coccyx pain

Spinal Cord Stimulators

See also personal experiences of spinal cord stimulators

Spinal cord stimulators (also known as neurostimulators) are devices which are designed to provide relief from chronic pain. A compact electronic device is surgically implanted in the wall of the lower abdomen, and connected by wire to a strip of electrodes placed next to the back of the spinal cord. The electronics supply low-voltage electrical pulses at the electrodes, which alter the pain signals in the spinal cord, providing partial or complete pain relief from pain. The stimulators are programmable, so that the signal can be adjusted for optimal pain relief after implantation.

Spinal Pumps

Spinal pumps, instead of delivering an electrical signal to the spinal cord, deliver small doses of a drug such as morphine to the space around the spinal cord. Because the drug is delivered to the spinal cord itself, much lower doses can be used than when the drug is taken orally or by injection, so that most side-effects of the drug can be avoided. The surgical procedure involves placing a drug reservoir and pump in the wall of the lower abdomen, and connecting a tube to the space around the spinal cord. The drug can be delivered in a controlled fashion by the pump in the reservoir. The reservoir can be refilled as necessary. The use of spinal pumps is also known as 'Intrathecal drug delivery'.

Dr Paolo Marchettini, a pain clinician in Milano, Italy, wrote to me about the use of these techniques in coccydynia:

To treat this pain I have applied electrical stimulators (produced by Medtronics USA), on the sacral roots. The patient has control of the system: it is possible to switch it on, off, or to modify the intensity. I had 3 excellent results out of 4 patients treated. The patient who had no benefit had the electrode easily removed.

In the patient who had no improvement with the spinal stimulator, I applied a catheter for spinal infusion of drugs (local anaesthetics and morphine). This solution has been effective and I now receive post cards from all around the world from this gentleman who before could not even sit at his desk.

The wire is positioned from the spine downward, toward the sacral roots, not around the coccyx itself. This treatment is also used for urogenital and anal pains, besides pain in the coccyx. The procedure is moderately invasive, may be performed under local anaesthesia, it does not imply any destruction of tissue, and it is completely reversible. If the patient has no benefit the electrode is easily removed, without harm or sequel. The international protocol requires a trial period with the electrode connected to an external battery, for the patient to evaluate the effects, followed by the implantation of the subcutaneous permanent battery. I consider this treatement before any destructive procedure (unless there is clear cut indication, before removal of the coccyx for example).

Since your website is in English and many of the readers are Americans, I may recommend Dr Kenneth Alo in Houston, Texas, who performs the same procedures.

Paolo Marchettini, Centro di Medicina del Dolore, Scientific Institute San Raffaele, Milano, Italy. Email: marchettini.paolo@hsr.it

The images below of implanted spinal cord stimulators are supplied courtesty of Dr Monachese, Oglio Po (Mantua) Hospital, Italy.

x-rays of a person with a spinal stimulator in place

CAT and MRI scans of a person with a spinal stimulator in place

CAT and MRI scans of a person with a spinal stimulator in place

More information on spinal stimulation and spinal pumps

Spinal cord stimulators are also made by Boston Scientific.

The Medtronics website has more information about the procedures, including the following question and answer:

Question: What are the possible complications associated with neurostimulation?

Answer: Any pain treatment can cause side effects. However, complication risks with neurostimulation are low. Please discuss this with your doctor. Neurostimulation does require surgery. As with any surgery, some risks exist. These risks include:

Some general complications that may be experienced with the system include:

Web links on spinal cord stimulators:

Review of spinal cord stimulation for back pain

Fact sheet from Medtronic, manufacturers of spinal cord stimulators

Updated: 2002-06-16

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