Spinal cord stimulators, also called dorsal column stimulators, help reduce chronic pain. They’re implanted into your spine to block pain signals from reaching your brain.

The field of spinal cord stimulation has increased rapidly in recent years, and now an estimated 50,000 spinal cord stimulators are implanted each year. The most common reason they’re implemented is to deal with chronic pain following failed back surgery, but they’re used to manage many types of chronic pain.

Read on to learn about spinal cord stimulation including potential benefits, risks, and how it works.

Spinal cord stimulators treat many types of chronic pain. Some of the conditions they’ve been used to treat include:

Pain signals travel from your body to your brain through your spinal cord. Spinal cord stimulation works by implanting electrodes into your spine to deliver bursts of electricity to block pain signals.

The electrodes are implanted into a part of your spine called your epidural space. Your epidural space is the area between your vertebrae and the outermost membrane of your spinal cord called the dura mater.

The electrodes are connected by wires to a generator implanted under your skin.

Spinal cord stimulators specifically block pain by disrupting nerve signals through a tract of fibers called your spinothalamic tract. This tract runs through your spinal cord and connects to a part of your brain called the thalamus. It regulates sensations of:

  • pain
  • temperature
  • crude touch
  • pressure
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A spinal cord stimulator consists of electrodes and a pacemaker-type device that send electrical impulses in the epidural space of the spine. It can help with back pain that has not responded to other treatments. Illustration: Whitney Williams.

The primary benefit of spinal cord stimulation is reduced chronic pain, which can improve your mobility, function, and quality of life.

Spinal cord stimulation can also help avoid the need for opioids for pain relief. Opioids pose serious risks to your health. Long-term use of prescription opioids can lead to tolerance and addiction.

Studies have found that the average degree of pain relief with high-frequency spinal cord stimulation ranges from 54% to 87%. More than 60% of people reduce or eliminate opioid use after switching to spinal cord stimulation.

Reviews of studies have found strong evidence that spinal cord stimulation is an effective treatment for chronic pain caused by failed lower back surgery where more conservative options have failed.

In a 2022 review of studies, researchers concluded that spinal cord stimulation is associated with improvements in pain, function, and opioid consumption.

Spinal cord stimulation is generally safe because implantation is minimally invasive and the procedure is reversible. The most common complications are related to device malfunction and may include jolting or sudden shock.

About 30% to 40% of people experience one or more complications. Electrode failure and migration are the most common.

About 3.4% to 10% of people develop an infection, which is the most common cause of device removal.

Serious complications are very rare, but can include:

Spinal cord stimulation may be considered for people with many types of chronic pain when nonsurgical treatments have failed. The procedure has proven especially successful for those with complex regional pain syndrome.

Spinal cord stimulation requires follow-ups, reprogramming, wound management, and wireless recharging. It’s important that potential candidates are willing to follow through with these commitments.

You’ll likely be given a psychological evaluation before receiving a spinal cord stimulator since active or untreated psychological disorders can lead to poor outcomes.

Types of spinal cord stimulators include:

  • Conventional implantable pulse generator: These implants have a battery that needs to be replaced every 3 to 5 years. It may be a good option if you have a condition that only requires a small amount of electricity.
  • Rechargeable implantable pulse generator: These implants have a battery that needs to be recharged regularly but usually lasts 10 to 15 years. They may be better if you have pain in multiple body parts that requires more electricity to treat.
  • Radiofrequency stimulator: These devices contain a battery located outside of your body. They’re rarely used today.

The process of receiving a spinal cord stimulator starts with a trial period before receiving a permanent implant.

Trial period

For your trial implant, your surgeon will implant one or two wires into your epidural space for about 1 week with a generator outside of your body. The trial is considered successful if it removes at least half your pain.

If the trial is unsuccessful, your surgeon can remove the wires relatively easily.

The surgery

If your trial is successful, you’ll receive a permanent implant. The procedure generally takes less than 2 hours.

You’ll be given local anesthesia around the surgical site to block pain. Many surgeons also use sedation to keep you relaxed and to keep you from moving.

Your surgeon will make an incision in the area where the generator will be implanted and another for the wires and electrodes. Once connected, your surgeon will make sure they’re working and close the incisions.

Recovery

You’ll likely be able to go home the same day as your procedure, but you won’t be able to drive yourself. You may experience some discomfort around your incisions for a couple of days afterward.

The risk of electrode failure or migration can be minimized by a 1- or 2-month restriction period where you limit bending, twisting, and lifting until the electrode is fixed into place.

Many people experience considerably less pain after their procedure than before, which allows them to enjoy a higher quality of life and more mobility.

The implant isn’t a cure for the underlying source of pain, and it’s difficult to obtain long-term pain coverage for longer than 5 years.

Factors that can diminish success include:

  • smoking
  • high use of opioids
  • psychological factors like depression and anxiety
  • older age
  • longer pain duration

Here are some frequently asked questions people have about spinal cord stimulators.

Can I get X-rays, MRIs, or CT scans with a spinal cord stimulator?

It’s usually safe to have an X-ray or CT scan if you have a spinal cord stimulator if it’s turned off during your procedure. High-frequency implants at 10kHz have received conditional approval for MRIs, but it’s important to ask your doctor if your device is MRI-compatible before your procedure.

Can I drive with a spinal cord stimulator?

A 2016 study found that the use of spinal cord stimulation wasn’t linked to increased motor vehicle collisions. However, most doctors recommend turning off your device while driving to avoid distraction.

Can I swim with a spinal cord stimulator?

You’ll be able to swim once your permanent spinal cord stimulator has healed into place. You won’t be able to swim or bathe during your trial. You may not be able to scuba dive since pressure may damage your implant.

Can I go through a metal detector with a spinal cord stimulator?

Your stimulator may set off metal detectors at airports and other locations. Your doctor will give you a special identification card to show that you have a spinal cord stimulator. It’s important to bring this with you while traveling.

Can a spinal cord stimulator be removed?

Surgeons can remove your spinal cord stimulator if it becomes ineffective or isn’t relieving your pain adequately.

Spinal cord stimulators are implanted devices that help block pain signals from your brain. They’re used to treat many forms of chronic pain, including back pain after failed surgery.

Studies have found that spinal cord stimulators can potentially offer moderate to high levels of pain relief, although everybody responds differently. Your doctor can help you figure out whether you make a good candidate.