Chronic Pain and Spinal Cord Stimulation

Living with pain that never fully goes away is exhausting. It can wear down your sleep, your mood, your work and your relationships, and it’s especially frustrating when you’ve already tried medicines, injections, physical therapy or even surgery and still hurt.

You don’t have to accept constant pain as your new normal. Dr. Betsy Grunch, a board-certified, Duke-trained neurosurgeon, helps adults with long-lasting back, neck and nerve pain find options that can work when other treatments haven’t, including spinal cord stimulation and intrathecal pain pumps.

Pain is called chronic when it lasts longer than three months. These are the chronic pain conditions Dr. Grunch treats most often:

• Failed back surgery syndrome: ongoing back or leg pain after one or more spine surgeries.
• Chronic low back pain and chronic neck pain: pain that continues for months despite treatment.
• Complex regional pain syndrome (CRPS): severe burning pain, swelling and skin changes, usually in an arm or leg, often after an injury.
• Neuropathic pain: burning, shooting or electric pain from damaged nerves.
• Painful peripheral neuropathy: nerve damage that often causes burning pain and numbness in the feet.

Before talking about a stimulator or pump, Dr. Grunch looks for a cause that can be fixed. A new MRI or CT scan may show a pinched nerve, a loose screw, a fusion that didn’t heal, or wear at the level next to an earlier fusion. When there is a structural problem like this, revision surgery or another spine operation can often correct the problem.

When there isn’t a clear problem to fix, or surgery isn’t the right choice, treatments that change how pain signals travel to the brain can help.

• Spinal cord stimulator (SCS): thin wires placed near the spinal cord send mild electrical pulses that block or change pain signals before they reach the brain. You try it first during a trial, going about your normal routine with temporary wires. If it relieves at least half of your pain, you can move forward with a permanent implant, which is usually an outpatient procedure.
• Intrathecal pain pump: a small pump placed under the skin of the belly delivers tiny doses of pain medicine directly into the fluid around the spinal cord. Because the medicine goes right where it’s needed, much smaller doses can be used than with pills.
• Battery exchanges, revisions and removals: Dr. Grunch also replaces worn-out batteries, fixes devices that have stopped working well, and removes devices when they are no longer needed, including for patients whose device was placed by another doctor.

Most insurance plans require a psychological evaluation before a spinal cord stimulator trial. This is a routine step, not a sign that anyone thinks your pain isn’t real.

• A surgeon’s view of your pain: Dr. Grunch can tell whether a fixable spine problem is behind your pain, so you aren’t offered a device when another surgery would help more, or the other way around
• Duke-trained and board-certified by the American Board of Neurological Surgery, and a Fellow of the AANS, ACS and CNS
• Experience: more than 5,000 procedures, with 400 to 600 surgeries a year
• Complete device care: trials, implants, battery exchanges, revisions and removals
• Second opinions: Dr. Grunch often sees patients who still have pain after surgery somewhere else
• Close to home: offices in Gainesville, Sandy Springs and Riverdale

Learn more about Dr. Grunch’s training and credentials.

What can I do if I still have pain after back surgery?

Start by having a spine surgeon look for a fixable cause, such as a pinched nerve, a loose screw or a fusion that didn’t heal. If one is found, another surgery can often correct the problem. If not, a spinal cord stimulator or pain pump may help when other treatments haven’t.

How does a spinal cord stimulator work?

Thin wires placed near the spinal cord send mild electrical pulses that block or change pain signals before they reach the brain. A small battery under the skin powers the system, and you control it with a handheld remote.

How do I know if a spinal cord stimulator will work for me?

You try it first. During the trial, temporary wires are connected to a small battery you wear, and you go about your daily routine while tracking your pain. If the trial relieves at least half of your pain, you can move forward with a permanent implant.

Is a spinal cord stimulator permanent?

It is meant to stay in place long term, but it can be adjusted, have its battery replaced, or be removed if it is no longer needed. Battery exchanges and removals are usually outpatient procedures.

What is the difference between a spinal cord stimulator and a pain pump?

A spinal cord stimulator uses mild electrical pulses to change pain signals, with no medicine involved. A pain pump delivers very small doses of pain medicine directly into the fluid around the spinal cord. Dr. Grunch will help you decide which, if either, fits your pain and your goals.

If chronic pain is wearing you down, Dr. Grunch can help you understand why it hasn’t gone away and what options are left. Call 470-293-9800 or contact us to schedule a visit at our Gainesville, Sandy Springs or South Atlanta (Riverdale) office. You can also ask general questions any time through our “Ask Us Anything” chat.

Related: All chronic pain conditions · All pain procedures · Lower back pain and back surgery · Pinched nerves and sciatica

This information is for educational purposes only and is not medical advice. It does not replace individualized care from a licensed physician. Please talk to your provider about your symptoms.