A Non-drug Therapy Option for Optimal Patient Outcomes

Spinal cord stimulation (SCS) is a proven, cost-effective therapy with significant advantages for patients with chronic neuropathic back pain. The largest study 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 failed back surgery syndrome (FBSS).¹

How Are Patients Selected for SCS Therapy?

SCS may benefit patients who meet the following criteria:

• Chronic, intractable neuropathic pain for more than 3 months
• Objective evidence of pathology concordant with pain complaint
• Lack of adequate relief from more conventional treatments
• Initial or further surgical intervention is not indicated
• No untreated drug habituation
• No contraindications to implantation
• Clearance and completion of psychological evaluation
• Clear function goals have been established

SCS can be used to manage chronic pain of the limbs that arises from diseases² 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 back pain patients, contact us.

Medicare Criteria for Evaluating Spinal Cord Stimulation Candidates

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.

Evaluating the Patient

The best candidates for SCS are patients who have neuropathic pain. The pain may be in the trunk or extremities, unilateral or bilateral. With the advent of multiple-lead systems and advanced programming, good results are achievable in many cases.⁴

The patient screening process generally involves the following:

• Assessing the patient’s health history and current condition
• Assessing the patient's psychological condition
• Determining the patient's expectations about SCS therapy
• Educating the patient
• Reviewing the system with the patient

To find a physician and additional patient information, visit poweroveryourpain.com.

Upcoming Events

Event Date	Event
October 22-25, 2009	70th Annual American Academy of Physical Medicine & Rehabilitation (AAPM&R) Annual Assembly & Technical Exhibition Austin Convention Center Austin, Texas USA

Educational Opportunities

Pacemaker for Pain Course
Accreditation: 1-hour CEU/CCM
Location(s): This course can be presented at your place of work or local CMSA chapter meeting.
For more information, email us.

¹Kumar 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.

²St. 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.

³NCD 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.

⁴Alò KM, Holsheimer J. New trends in neuromodulation for the management of neuropathic pain. Neurosurgery. 2002 April;50(4):690-704.

Indications for Use: Chronic, intractable pain of the trunk and limbs.

Contraindications: Demand-type cardiac pacemakers, patients who are unable to operate the system or who fail to receive effective pain relief during trial stimulation.

Warnings and Precautions: Diathermy therapy, cardioverter defibrillators, magnetic resonance imaging (MRI), explosive or flammable gases, theft detectors and metal screening devices, lead movement, operation of machinery and equipment, postural changes, pediatric use, pregnancy, and case damage. Patients who are poor surgical risks, with multiple illnesses, or with active general infections should not be implanted.

Adverse Events: Painful stimulation, loss of pain relief, surgical risks (e.g., paralysis). Clinician’s manual must be reviewed prior to use for detailed disclosure.

Caution: U.S. federal law restricts this device to sale and use by or on the order of a physician.