PM recommending test for SCS...Experiences? Remarks? Thoughts?

Went to my PM for monthly appointment today.

I've been having higher and higher levels of pain, and more breakthroughs lately. I asked what my options were. Dr Matsumura suggested that we could look at higher levels of medications, or look at a spinal cord stimulator (SCS). He uses the Precision Plus from Boston Scientific.

I would sure appreciate the words of wisdom and thoughts from anyone who has a stimulator, and particularly one from Boston Scientific, installed.

In addition, the opinion of anyone who is testing or has tested and not yet installed or not going to install and why not.

I think this is one of them junction points where what I decide is going to have major influence on my life for a long time and I'd like to try to do it right.

Your help is very much appreciated. Thank you.

PS- are your pups labs or lab mixes? They are adorable!! I have a black lab, Mr. B (his real name is Brodie). He is my therapy!!!

Chomp is a lab/Great Dane mix. Koshka is a lab/Border Colllie mix (we think; lotsa signs she could be any number of breeds (how can you tell if you don't know the owners?)). Both were rescues.

Tony, As was stated, I am in the process of having the impland of the same unit you described. I did a 7 day trial and after a modification 2 days after the trial started, I was ablt to use the stim to address pain during the day. I tried to keep a regular schedule during the trial to see how I responded. I used the stim 24 hours a day. At night I had it on low to see if sleep would improve, which it did not. I did find that during the day, it distracted the effects of pain and I stopped my methadone during the day. I try not to take much during the day anyway and as I work, I don't allow the pain to stop me much.

The PMS was hesitant to go ahead with the implant as it did not address my night time pain which has been my biggest complaint anyway. He finally decided to go ahead with the idea that it would allow me to not to use meds during most days.

I just had my appoint. with my surgeon (did my fusion last year) and he also was hesitant. Again the same issues camm up. I was scheduled for the implant on 6/1/09 and just received a call and it has been postponed to 6/8/09. There was a scheduling error at the hospital. I am going to have the transmitter placed above the belt line on my left side. That way it will not effect the sitting and possible discomfort as well as  well as any rubbing of the belt. I am not concerned that some day I may have my shirt off and someone will see a scar or lump.

I also asked the important question as to further diagnostic imaging limitations with the implant. My surgeon stated that while the transmitter is implanted, no mri's can be done. Other tests can. He stated that if necessary, the transmitter can be removed, the leads or paddles can be left in place and then an MRI can be done. This seems to contradict information from others but he assured me that he has had patients who he has removed the transmitter and had an  MRI done with the paddles in place.

I will be awake for most of the procedure as he does a different level of anestesia at the start and then  will wake me up after the paddles are placed so the positioning of the paddles can be done. The Boston Scintific Rep. will be in the operating room during the procedure so they can hook me up to a computer as soon as the paddles are in place. 

As my surgeon knows my work schedlue, he stated that if I felt comfortable enough the following day, I could return to work but thought a couple days off would not be all that bad. Then 10 days later I will have the staples removed. What else can I share that will help you. 

Tony, during the trial, I likened it to sitting in a chair that vibrates, only your outsides don't vibrate just your insides. At times I would turn it up high to keep from feeling any pain and my wife would comment that my feet would have tiny jerks. I switched the programs back and forth to keep from having one feeling that would get monotonous. What I would do over at this point. I would have shaved my back before the trial as they forgot to. They tape the unit to your back and the tape is tough. I should have asked some of the questions of my PMS that I asked my surgeon. Where the transmitter can be placed? What options of leads and paddles? I asked my surgeon to keep me alert as much as possible. I have a problem with my bladder not responding after surgery. I had 4 cathiters inserted in 4 days and last surgery I had a cathiter in for 3 weeks after surgery. The surgeon is going to push an IV to try and help me out. I will keep you posted. If you have questions, let me know and I will be glad to ask the drs to see if you get the same answer.  

Tony,

I don not yet have a stim but I am a candidate and I have been doing lots of research. I am an electrical engineer so I am especially interested in the technology involved. What I have to say next is purely from my engineering perspective not a personal one since I can't speak from experience yet.

The Boston Scientific and Medtronic units are similar in function (delivering electrical pulses) but quite different in the way they go about it. Boston Scientific uses CONSTANT CURRENT and Medtronic uses CONSTANT VOLTAGE technology. Think of voltage being like water pressure and current being the amount of water flow in a hose. Think of resistance as anything that impedes or restricts the flow of water.

To continue the hose analogy, the constant pressure from the street mains is like constant voltage. The resistance is friction in the hose or anything in the stream that restricts the water movement. The current is the resulting flow of water at the end of the hose. This system is constant pressure or constant voltage, the Medtronic technology. As scar tissue forms around the leads it acts as resistance to the electrical pulses. Like partially closing a valve at the hose end. The result is a decrease in water flow or a decrease in current if you will. It is the current that does the work in a stim system.

With the Boston Scientific and any constant current system, the computer is programmed to deliver a constant current under varying resistance. It would be like increasing the hose pressure at the street to offset any partial closure of the hose valve in order to maintain the desired water flow or current. So in the body, as scar tissue (resistance) increases, the computer senses a reduction in current and increases the voltage to compensate. All within programmed limits I'm sure.

I am not a doctor but from an engineering point of view, it would seem to me that constant current would likely deliver more stable pain relief over time as scar tissue forms. I would guess that is why the newer stim designs like BS and now the St. Jude medical device are designed this way. I would encourage you to discuss this idea with reps from both companies to get some direct input for your specific case. Again this is just from an engineer's point of view.

I hope this helps. I wanted to be as fully informed as possible before I made my decision. I am still doing my research.

Hope this helps.

Modelmaker

Tony,

Glad I could help

Good luck to you in whatever your choice for stim.

Please keep us informed as you go forward as I and perhaps others will be facing similar decisions in the near future.

Modelmaker

Tony -  mine is made by Medtronic.

Immensely helpful, FJ.

As you can see, I'm becoming a late-nighter myself. Between the change in my pain pattern, and the change in my overall sleep patterns, things are really disrupted here.

Thank you to everyone who is responding; I hope to get back to you individually in the next few days.

Ms Kitty, I realized that you are an amputee, but didn't realize the level of neuropathy. Can I assume they are interrelated?


Heading off to bed. Hope this didn't sound too disjointed. Talk to you later today.