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In this procedure, one or two wires are
placed into the epidural space to provide electrical stimulation
of the spinal cord, acting to interfere with the transmission
of pain. This technique is very effective in arm and leg
pain caused by nerve injuries and can also be useful in
some low back pain not relieved by surgery. It has also
been used to treat pain from vascular insufficiency and
chest pain. The stimulation can be turned on and off or
adjusted by the patient, thereby adding an element of
personal control to the treatment of pain.
The wires and the electrical generator are surgically
placed. Prior to such permanent placement, a trial is
performed. In this trial, the wires are placed through
the skin without an incision and attached to an external
power supply worn on the patient's belt. The patient may
then go home and use the devise for several days to determine
its effectiveness in treating pain. Only if the patient's
painful area receives stimulation and if this stimulation
reduces pain and improves the patient's function is a
permanent implant considered.
The permanent implant may consist of small wires or large
flat paddles. The flat paddles require a more extensive
surgical procedure called a laminectomy but provides more
efficient energy output, less chance of movement and more
extensive coverage. The decision regarding the type of
implant to be used is made on an individual basis, based
on the pattern of the patient's pain, the results of the
trial stimulation, and the patient's preference. |
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