نشر يوم 25. February 2020

Impulse generator

In modern pain therapy, a spinal cord stimulator can help patients who are commonly considered "out of treatment." Dr. Vasileios Ntoukas, head of spinal surgery and specialist in neurosurgery at the Vivantes Hospital „Am Urban“, explains how the pain pacemaker works and what it can do.

Every fifth person in Germany suffers from chronic pain. Recurring or persistent, it occurs over a period of at least three to six months - and thus becomes a defining part of life, associated with many limitations. The most common form is back pain, often accompanied by concomitant conditions such as neck pain, migraines or sleep disorders. For those affected, these painful conditions are grueling and often leave them in despair. A promising therapy option is the insertion of a spinal cord stimulator.

Dr. Ntoukas, what exactly is a pain pacemaker and how does it work?

It is a small device, only a few centimeters in size, that is coupled to an electrode that prevents certain nerves from transmitting pain information to the brain. The pacemaker generates electrical impulses, fine metal wires transmit these to the spinal cord and ensure that the transmission of the pain signal is weakened or even interrupted. This means that the information "pain" reaches the brain either weakened or not at all. Instead, the patient feels a tingling sensation in the respective pain area. In recent years, however, the stimulation programs have undergone such technical development that the tingling sensation has been completely eliminated.

What chronic pain can be treated with this procedure?

A whole range of different types of pain. For example, permanent back pain or combined back and leg pain, often already pre-operated several times in intervertebral discs or stiffening operations. Or pain caused by peripheral arterial occlusive disease, also called shop window disease, in which the blood vessels that supply oxygen to the legs are narrowed. Also phantom limb pain and polyneuropathy, diseases of the peripheral nervous system that affect multiple nerves. Also the Complex Regional Pain Syndrome, pain after shingles as well as also the out of treatment angina pectoris, i.e. heart pain. It is also important that the pain medication, which is also associated with side effects, can usually be significantly reduced.

Can you test in advance whether the pain pacemaker helps the patient?

Yes, we test it in advance by placing a fine electrode on the spinal cord skin. The procedure is performed on an outpatient basis under local anesthesia. We connect the electrode implanted in this way to an external generator. Within the next few days, the patient's daily life will show how the pain improves. If the improvement is 50 percent or more, we can implant the actual pacemaker.

The Spinal Cord Stimulator 

A battery-powered "pulse generator" (IPG) is implanted under the skin, minimally invasively, usually above the buttocks or on the abdomen. One or more electrodes emanate from the IPG to stimulate nerve fibers in the spinal cord. Changing the intensity of the current and other parameters of the stimulation can result in pain relief. The electrical impulses superimpose a slight tingling sensation (paresthesia) on the pain signal, which is now eliminated due to continuous development. Using a remote control, patients can turn the system on or off, change programs depending on the type of pain, intensity or activity, and adjust the stimulation accordingly. The new, rechargeable devices usually last a lifetime, but the batteries have to be replaced after about 10 years. The pain pacemaker was first used in 1967 and has since been used to treat more than 400,000 patients worldwide. Continuous advances in technology have led to a significant expansion of the target group for this form of therapy and increased awareness.

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