Case Managers
SCS (also called neurostimulation) is a cost-effective therapy with advantages for patients with chronic neuropathic back pain, especially when the pain is related to failed back surgery syndrome (FBSS).1,2 One of the largest studies of SCS to date has shown that compared with conventional medical management alone, SCS improves pain relief, quality of life, functional capacity and patient satisfaction in selected patients with neuropathic pain related to FBSS.2
Spinal cord stimulation is a chronic pain management option that works by intercepting pain signals before they reach the brain. To do this, a small system is implanted in the body. When turned on, this implanted system sends mild electrical pulses to nerves along the spinal cord, diminishing the feeling of pain. With proper patient selection, as well as correct device selection and positioning, SCS can be a highly successful long-term solution for certain types of chronic pain.
SCS may benefit patients who meet the following criteria:
- Patients with chronic pain of the trunk or limbs, whose pain is physiological in origin and of the type treatable with neurostimulation
- Patients with neuropathic pain (marked by burning, tingling or numbness)
- Patients with little or no relief from surgery or other treatment options, such as pain medications, nerve blocks, TENS, or physical therapy
- Patients who are able to operate the device
- Patients who are suitable candidates for surgery and free of active general infections
SCS can be used to manage chronic pain of the limbs that arises from diseasesa such as:
- CRPS (Complex Regional Pain Syndromes I and II)
- Peripheral neuropathy
- Peripheral ischemia
To learn more about how SCS may be able to help your chronic pain patients, contact us.
Medicare covers the costs for an SCS system and the implantation procedure. Currently, Medicare requires the following criteria to be met in order to cover the costs for SCS3:
- The implantation of the stimulator is used only as a late resort for patients with chronic, intractable pain.
- Other treatment modalities (e.g., pharmacological, surgical, physical, or psychological therapies) have been tried and have not satisfactorily treated the patient, or these treatments are judged to be unsuitable or contraindicated for the given patient.
- The patient has undergone careful screening, evaluation, and diagnosis by a multidisciplinary team before implantation. Screening must include a physical and a psychological evaluation.
- All facilities, equipment, and professional and support personnel are available to properly diagnose, treat, train, and follow up with the patient.
- Before permanently implanting an SCS system, physicians must demonstrate that the therapy relieved a patient’s pain by 50% or greater during an SCS trial.
To find a pain specialist and additional information about SCS, visit poweroveryourpain.com.
Pacemaker for Pain Course
Accreditation: 1-hour CEU/CCM
Location(s): This course can be presented at your place of business or local CMSA chapter meeting.
For more information, contact us.
a St. Jude Medical SCS devices are intended to aid in the management of chronic intractable pain of the trunk and/or limbs, which may have derived from specific disease states or diagnoses. St. Jude Medical neurostimulation systems are not intended to treat or cure specific disease states or diagnoses.
1. Kumar K, Malik S, Demeria D. Treatment of chronic pain with spinal cord stimulation versus alternative therapies: cost-effectiveness analysis. Neurosurgery. 2002;51(1):106–116.
2. Kumar K, Taylor RS, Jacques L, et al. Spinal cord stimulation versus conventional medical management for neuropathic pain: a multicenter randomized controlled trial in patients with failed back surgery syndrome. Pain. 2007;132:179-188.
3. NCD for Electrical Nerve Stimulators. Center for Medicare and Medicaid services Web site: http://www.cms.hhs.gov/mcd/viewncd.asp?ncd_id=160.7&ncd_version=1&basket=ncd%3A160%2E7%3A1%3AElectrical+Nerve+Stimulators. Accessed February 19, 2009.