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Spinal Cord Stimulation

ReActiv8

Intracept

Cervical medial branch block

Cervical Radiofrequency

Cervical Epidural

Lumbar Medial Branch Block

Lumbar radiofrequency

Lumbar Epidural

Sacroiliac Joint injection

Sympathetic Nerve blocks

Trigger point injections

Spinal Cord Stimulation

Spinal cord stimulation is a form of neuromodulation that is an effective alternative treatment for certain chronic pain disorders. This consists of a small implantable device that delivers electrical signals through the epidural space to interfere with pain signals. Instead of feeling pain, patients may experience comfort or relief. Spinal cord stimulators can treat different types of chronic pain syndromes, including back pain, neck pain, radicular pain, neuropathic pain, chronic regional pain syndrome and more.

Indications for spinal cord stimulation:

  • Failed Back Syndrome (FBS) or low back syndrome or failed back
  • Radicular pain syndrome or radiculopathies resulting in pain secondary to FBS
  • Multiple back operations
  • Unsuccessful disk surgery
  • Degenerative Disk Disease (DDD)/herniated disk pain refractory to conservative and surgical interventions
  • Peripheral causalgia
  • Epidural fibrosis
  • Arachnoiditis or lumbar adhesive arachnoiditis
  • Complex Regional Pain Syndrome (CRPS), Reflex Sympathetic Dystrophy (RSD), or causalgia
  • Diabetic peripheral neuropathy of the lower extremities
  • Certain types of stimulators can even be indicated for: Causalgia secondary to inguinal or umbilical hernia repair, Total knee or total hip replacements, Sacral pain or pelvic pain.

What to expect

If you are identified as a possible candidate for a stimulator, here are some steps you can expect.
**Most insurances will require a psychological assessment prior to this therapy.

Trial:

  • Unlike most other medical treatment options, you can try the stimulator before committing to long-term therapy.
  • The trial is typically done in-office and involves the placement of temporary epidural leads that are attached to an external battery for 5-7 days.
  • At the end of your trial, we can make a shared decision to determine whether or not stimulation therapy is right for you. A successful trial is typically described as at least 50% relief in pain, however other clinical indicators are important to consider, such as functional improvement or disability improvement.

Implant:

  • The permanent implantation is done in an ambulatory surgery center or hospital depending on your medical history. You can expect to be home the same day as your surgery with two small incisions, one for the leads and one for the battery pocket.

Long-term management:

  • As your pain changes, so too can your spinal cord stimulator. This is one of the great components of this therapy. With thousands of different options for reprogramming, you can work closely with your provider to continue to tailor this therapy for you.

Frequently Asked Questions:

If you google spinal cord stimulators (SCS), you may see advertisements from law firms touting the ‘dangers of spinal cord stimulator devices.’ This will naturally raise your concern as to whether or not this therapy is right for you. Rest assured; spinal cord stimulation therapy is safe. This technology has been around since the 1960’s and has only improved with time. According to the FDA, the most frequently reported patient problems with SCS are inadequate pain relief or battery charging issues. These are resolved with proper patient selection, an adequate trial period and proper device selection. Please speak with a provider here at New York Pain Pump Institute to determine how to maximize your experience with spinal cord stimulation. Feel free to review the following letter to healthcare providers from the FDA regarding adverse events with SCS. 

https://www.fda.gov/medical-devices/letters-health-care-providers/conduct-trial-stimulation-period-implanting-spinal-cord-stimulator-scs-letter-health-care-providers

Not all SCS devices are MRI compatible, some are non-compatible or MRI conditional. Please speak with a provider here at The New York Pain Pump Institute to determine which device best suits your needs.
As with any medical treatment, there are risks and benefits. Risks can include surgical complications, surgical site infections or hematomas. These complications can be managed, and permanent damage is very rare. Complications with SCS therapy can include lead migration, lead fracture, or impedances. The team here at The New York Pain Pump Institute can work with you to minimize your risk of surgical complications or device related complications. Make an appointment to learn more.
From the surface, you probably identify a similarity between SCS and a tens unit, they both use electrical energy to control pain. This is where the similarities end. SCS is vastly superior to a tens unit in more ways than one. There is no evidence to suggest whether your experience with a spinal cord stimulator will relate to your experience with a tens unit, meaning, your experience with a tens unit will not be an indication of whether a spinal cord stimulator is right for you. Only a trial with a spinal cord stimulator is an adequate predictor on the efficacy of spinal cord stimulation.
At The New York Pain Pump Institute, we are proud to work with all device manufacturers. Each and every patient is different. In our opinion, there are clinical situations where one specific device is right for one specific person. In other circumstances, patient preference or experience may drive the decision to one manufacturer versus another. Make an appointment today to learn more about how we can guide you through this decision and give you the best experience possible with spinal cord stimulation.
No. There has never been any confirmed or documented evidence of a stimulator electrocuting a patient.

ReActiv8

An innovative approach to chronic lower back pain, Reactiv8 is a restorative neurostimulation device. It works to stabilize the muscles in your lower back and reverse the cause of your pain.

What to expect:

  • Unlike the spinal cord stimulator or IT pump, the Reactiv8 therapy does not require a trial prior to implantation. Through MRI or physical exam, the providers at The New York Pain Pump Institute can determine if you are a good candidate for this therapy.
  • The device works by delivering two thirty-minute sessions each day. These sessions are programmed to provide a comforting sensation and are not painful.
  • Most patients will start to feel pain relief and functional improvement between 6 and 16 weeks (about 3 and a half months).
  • In a 3-year durability study, over 80% of patients with Reactiv8 reported clinically substantial improvement in pain, disability or both.
  • * Three-Year Durability of Restorative Neurostimulation Effectiveness in Patients with Chronic Low Back Pain and Multifidus Muscle Dysfunction. Neuromodulation Journal. Sept. 2022. Gilligan et. al.

Implant:

  • The implantation is done in an ambulatory surgery center or hospital depending on your medical history. You can expect to be home the same day as your surgery with two small incisions, one for the leads and one for the battery pocket.

Management:

  • Ten to fourteen days after implantation, you will be scheduled an activation appointment. During this appointment, your device will be turned on and programmed to your individual needs.
  • After the activation appointment, intermittent follow-ups at one, three and six months are done to reprogram the device as your body starts to heal and restore spinal stability.
  • The procedure is entirely reversable and if you feel that you have achieved maximum improvement at any time, the device can be safely removed. Speak with a provider at The New York Pain Pump institute about the pros and cons of removing this device.

Frequently Asked Questions:

No, the battery is a primary cell battery, and does not need to be charged.
It is preferred for you to complete therapy sessions while laying down. The absolute best position is lying face down. The goal is to keep the muscles in your back fully relaxed with the least amount of strain or pressure on the leads. Speak with a Reactiv8 clinical rep prior to implantation to discuss your personal needs to develop a plan to optimize your therapy sessions.

Adherence to the therapeutic sessions is most important in the first year of implant. Each patient is different and as your body starts to heal, your plan and therapy will adjust.

Visit: https://lowbackpainrecovery.com/ for more information or make an appointment with The New York Pain Pump Institute.

Intracept

A targeted intervention for the treatment of vertebrogenic back pain, a unique type of pain caused by the degeneration of the vertebral endplates. This degeneration has been coined ‘Modic changes’ and can be found on MRI. Modic changes induce pain because of the basivertebral nerve, a sensory nerve that sends pain signals when there are modic changes.

What to expect:

  • The procedure is implant free and minimally invasive. Completed as a same-day procedure, Intracept uses radiofrequency waves, similar to that in an MRI machine, to ablate the basivertebral nerve. You can plan to go home the same day without any surgical incisions.
  • Outcomes: Intracept is a safe procedure that provides reproduceable and durable relief of chronic lower back pain.
  • The company has sponsored three clinical trials including approximately 400 patients. The outcomes were safe, reproduceable, durable and effective.

Cervical medial branch block

A possible generator for your neck pain are small joints, called facet joints. These joints allow your neck to move and are susceptible to injury and degeneration.

The medial branch nerves of your spinal cord are responsible for sending the pain signals from this joint to your brain.

A medial branch block is an office-based procedure, performed with fluoroscopic guidance where a long-acting anesthetic is delivered to the medial branch nerve.

The purpose of this procedure is to diagnose the facet joint as a pain generator. Pain relief is variable for everybody. If you experience short-term pain relief, you may be recommended to have a cervical radiofrequency.

Cervical Radiofrequency

After experiencing a positive result with a cervical medial branch block, you may be offered a cervical radiofrequency.

Just like the medial branch block, this office-based procedure targets the medial branch nerves sending pain signals to your brain from the facet joint.

However, unlike the medial branch block, instead of local anesthetic, this procedure uses radiofrequency energy, similar to that of an MRI machine. The difference here is this energy can ablate the medial nerve, stopping the pain signals from reaching your brain for up to six months.

Cervical Epidural

Cervical epidural injections are procedures designed to relieve neck pain associated with inflammation or pressure around the nerves in the neck.

This inflammation can be caused by multiple different pathologies including spinal stenosis, neural foraminal stenosis, herniated discs, degenerative disease, or inflammatory disease. The epidural space is the space surrounding the outer most layer of your spinal cord.

The nerves in your neck will travel through the epidural space prior to extending into your shoulders and down your arms. Using Fluoroscopic guidance, steroid and anesthetic medication can be injected into this space to treat a variety of conditions that may irritate the cervical nerve root.

What you should know

  • Patients can expect a modest increase in pain directly after their cervical epidural as the medication will increase the amount of pressure on the spinal cord and surrounding nerve roots temporarily. As the medication starts to disperse you can expect pain relief.
  • Pain relief is different for everybody, depending on your pain and your individual condition, repeat injections may be required to achieve optimal outcomes.

Lumbar Medial Branch Block

A possible generator for your lower back pain are small joints, called facet joints. These joints allow your lower back to move and are susceptible to injury and degeneration.


The medial branch nerves of your spinal cord are responsible for sending the pain signals from this joint to your brain.
A medial branch block is an office-based procedure, performed with fluoroscopic guidance where a long-acting anesthetic is delivered to the medial branch nerve.


The purpose of this procedure is to diagnose the facet joint as a pain generator. Pain relief is variable for everybody. If you experience short-term pain relief, you may be recommended to have a lumbar radiofrequency.

Lumbar radiofrequency

After experiencing a positive result with a lumbar medial branch block, you may be offered a lumbar radiofrequency. Just like the medial branch block, this office-based procedure targets the medial branch nerves sending pain signals to your brain from the facet joint. However, unlike the medial branch block, instead of local anesthetic, this procedure uses radiofrequency energy, similar to that of an MRI machine. The difference here is this energy can ablate the medial nerve, stopping the pain signals from reaching your brain for up to six months.

Lumbar Epidural

Lumbar epidural injections are procedures designed to relieve lower back pain associated with inflammation or pressure around the nerves in the lower back. This inflammation can be caused by multiple different pathologies including spinal stenosis, neural foraminal stenosis, herniated discs, sciatica, degenerative disease, or inflammatory disease. The epidural space is the space surrounding the outer most layer of your spinal cord. The nerves in your lower back will travel through the epidural space prior to extending into down your legs. Using Fluoroscopic guidance, steroid and anesthetic medication can be injected into this space to treat a variety of conditions that may irritate the cervical nerve root.

What you should know

  • Patients can expect a modest increase in pain directly after their cervical epidural as the medication will increase the amount of pressure on the spinal cord and surrounding nerve roots temporarily. As the medication starts to disperse you can expect pain relief.
  • Pain relief is different for everybody, depending on your pain and your individual condition, repeat injections may be required to achieve optimal outcomes.

Sacroiliac Joint injection

Designed to diagnose and treat sacroiliac joint dysfunction, the sacroiliac joint injection is a minimally invasive office-based procedure that frequently benefits many people suffering from chronic lower back pain. The sacroiliac joints are located at the bottom of the spine on either side of the sacrum. Dysfunction of this joint can cause hyper or hypomobility and pain.

What you should know

  • The injection is done under fluoroscopic guidance in the office. A combination of steroid and local anesthetic is used for the medication.

Sympathetic Nerve blocks

The sympathetic nerves help make up your autonomic nervous system and are located outside of your spinal column. They are responsible for all sorts of functions including neuropathic pain, sweating, body temperature regulation, heart rate and much more. In some pain conditions, like chronic regional pain syndrome (CRPS), the sympathetic nervous system could inappropriately transmit pain signals, in which case, we can block these signals with a sympathetic block.

What you should know

  • A sympathetic block can be performed in multiple different locations.
  • Stellate ganglion block would be in your cervical column and would address upper extremity, neck, and head pain.
  • Ganglion Impar sympathetic block is done in the sacrococcygeal junction and is used to address perineum pain.
  • Celiac plexus block would be completed in your mid-back, or thoracic column and would address chronic pain associated with digestive organs, such as your pancreas, gallbladder, intestines, liver or stomach.
  • Lumbar sympathetic block is done in your lumbar spine and addresses neuropathic pain syndromes such as CRPS or causalgia in your lower extremities.
  • Superior hypogastric plexus block is done at the L5-S1 level and is done to address sympathetic pain in the pelvis.

Trigger point injections

Myofascial pain is a common pain syndrome, either presenting independently on its own as, or as a sequelae of other underlying pain conditions resulting in worsening pain. Frequently, you will hear people refer to this colloquially as ‘Knots’ in your muscles. This pain condition can develop in any muscle, but certain muscle groups are more commonly affected than others, such as the neck, lower back, hips and shoulders.

What you should know

  • Trigger point injections (TPI) are superficial injections of a mixture of anesthetic and steroid designed to help relieve the ‘knot.’ Both the dissection of the muscle with the needle and the injection of medication are helpful to provide both immediate and lasting relief. TPI are common procedures and are frequently combined with different forms of home exercises, massage or physical therapy.

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