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Tripler Army Medical Center Public Affairs
HONOLULU — The use of spinal cord stimulators to treat chronic pain has evolved at Tripler Army Medical Center, here.
In 2011, the Food and Drug Administration approved the use of spinal cord stimulators using a percutaneously delivered (through the skin) paddle lead and a battery-operated pulse generator that senses a patient’s position. The approval of these implanted devices made a nice addition to TAMC’s Integrative Pain Management Clinic.
The clinic, priding itself on trying to reduce the use of opiates to treat pain, had already been performing spinal cord stimulator implants using cylindrical leads.
The leads used by spinal cord stimulators are wires that go from the stimulator device to the spinal cord. The wires deliver signals that will interrupt the feeling of pain. More than 90 percent of the leads placed at Tripler are percutaneous. Paddle leads use less energy, meaning patients recharge the battery in the stimulator less frequently. The cylindrical leads send energy everywhere, all around the lead, while the paddle leads sends energy to just the spinal cord.
Tripler’s Dr. Phillip Lim, pain management physician, IPMC, who performed the first paddle lead implant in Hawaii at Tripler in February, said a lot of patients say the implant feels like a massage when the neurostimulator is activated.
“A few patients have even moaned from relief when I turn on the stimulation,” Lim said with a laugh. “The technology has gotten so good over the years (with spinal cord stimulators).”
Maj. Brian McLean, chief, Pain Medicine and Interventional Pain Services, TAMC, said this treatment is for patients with severe neuropathic pain, who have exhausted all other avenues of relief and treatment.
“We start with a three-to-seven day trial using a temporary lead similar to an epidural (an injection through a catheter placed into the epidural space of the spine),” McLean explained. “We do not want to (implant) a permanent lead unless the trial offers them at least 75-percent pain relief and improvement in function.”
For Maggie Peeler, who recently received a permanent cylindrical lead implant, the spinal cord stimulator promises her relief from lower back and leg pain after an injury 10 years ago. Peeler said, after her five-day lead trial, when Tripler removed the temporary lead, she realized how much pain she had learned to live with and was anxious to receive the permanent lead.
“The procedure is done on a large number of patients for a wide variety of neuropathic pain reasons,” McLean added. “It is a very powerful tool to help with chronic pain, and unlike medications and injections, it’s not temporary relief. It is continuous, long-lasting relief.
“(In addition to the lead advancements), the new batteries are sensor batteries and will sense the patient’s movement and adjust stimulation based on the position of their body,” McLean continued.
McLean said the important thing for beneficiaries to know is that the IPMC can provide pain relief without pain medications.
“Our goal is to not just improve their level of pain, but their function,” McLean explained, adding that a spinal cord stimulator has also aided in retention and readiness. “Soldiers have even deployed with the spinal cord stimulator in. It saves the Army from discharging a Soldier with severe chronic pain.”
To view more photos, visit www.flickr.com/TriplerAMC.