Former firefighter Jolene Hammons lived with chronic back pain and high doses of opioids for more than a decade before she found relief with a spinal cord stimulator.
An estimated 50 million adults live with chronic pain, which is associated with decreased quality of life, opioid dependence and poor mental health. Hammons, a Whispering Pines resident, became familiar with the consequences of persistent pain and the possible pitfalls of using opioids to treat chronic issues.
“The original doctor I had was essentially overdosing me on painkillers,” she said. “Every time I would stand up, I would pass out. My blood pressure would bottom out. Then I was put on Duragesic patches, which made me sick quite often and I kept wondering why I was getting the flu. I watched a TV program on fentanyl and realized I was using a fentanyl patch and having withdrawals.”
Hammons switched doctors. After watching family members struggle with addiction, she decided she wanted a shot at living unmedicated. She started working with Rob Thomas, PA-C, at FirstHealth Interventional Pain Medicine in Pinehurst and asked to be taken off opioids. Thomas helped her taper off Duragesic and agreed that, after Hammons reached one year without fentanyl, she could try a spinal cord stimulator to treat her refractory back and leg pain.
Spinal cord stimulators (SCS) are small, surgically implanted devices that send low levels of electricity into the spinal cord to help relieve pain. Electrodes are placed between the spinal cord and vertebrae and patients can use a remote control to send electrical impulses to the spine that work to interrupt pain signals before they reach the brain.
Thomas said SCS therapy can be a beneficial option for patients who haven’t experienced improvement with standard treatment, which may include pharmaceuticals, epidural steroid injections, nerve root blocks, radiofrequency ablation and surgery.
“Most of our patients have been put through the conventional medical management cycle without finding relief,” he said. “A lot of our spinal cord stimulator candidates are classified as failed back surgery syndrome patients. They’ve had surgery and outcomes were not favorable. Other categories of patients that qualify for this therapy include those with post-laminectomy syndrome, non-surgical refractory back pain, painful diabetic neuropathy, arachnoiditis, phantom limb pain and complex regional pain syndrome.”
All patients must complete a spinal cord stimulator trial, which lasts around seven days, before moving forward with implantation. During the trial, small wires are placed into the epidural space and held in place with an anchoring mechanism that hooks the wires to the stimulator battery. The device has a wide variety of different programs and settings, and patients have the chance to test various settings during the trial.
For a trial to be considered successful, Thomas said providers look for a few key components, including:
- A greater than 50 percent reduction in pain
- Increased mobility and the ability to perform daily living activities without usual impairments
- Improved sleep
- A reduction in pain medication dosage
If the trial is a success, the patient can then have the stimulator implanted. The procedure is typically performed by an orthopaedic spine surgeon or a neurosurgeon in an outpatient setting.
For Hammons, SCS therapy has greatly improved her quality of life. In the three years since implantation, she went from not having the strength to grocery shop or vacuum to being able to participate in daily activities again.
“The biggest thing I’m proud of is, once a month, I do a six to 10-mile hike with a group of advocates for the prevention of veteran suicide,” Hammons said. “I’ve been able to do five hikes with no pain. I can spend the whole day with my daughter, going out to get our nails done and shopping, and I’m not complaining to her that I can’t keep up.”
Thomas attributes new SCS technology to higher success rates. Older devices would typically work for a year, maybe two, before patients would say they were no longer effective and request to have them removed.
“With the new systems, we’ve had people who have the system greater than five years and they’re still reporting greater than 50 percent of pain relief. They’re still functioning better and taking less pharmaceuticals,” Thomas said.
Data from a randomized controlled trial, published in the Journal of Neurosurgery: Spine, showed that at 12 months, 78.2 percent of participants reported greater than 50 percent of pain relief with the spinal cord stimulator. Of the 145 participants in the study, only two percent requested the device to be explanted, or removed, due to wound complications.
Lauren Sylvester Mokris, M.D., an anesthesiologist and pain management physician at FirstHealth Interventional Pain Medicine, said SCS therapy has been a positive addition to the clinic’s variety of innovative techniques.
“We know treatment plans are never one size fits all and it’s important to work with patients’ unique histories and diagnoses to find what is most efficient for them,” she said. “Our goal is to stop or reduce chronic pain to the greatest extent possible and offering spinal cord stimulation therapy has certainly aided in that mission as one of many possible therapies.”
So far, Hammons has not encountered any major issues with her SCS device.
While she did have her initial device replaced after she accidentally pulled the leads out of position, she received a new device and works with the reps to try new programs. She is still in search of the sweet spot she found with the first device, which left her 95 percent pain free.
“There’s so many different algorithms and I know once we find the right setting, I’ll get back to being largely pain free. But 10 to 15 percent pain is still better than lying in bed, not able to do a thing,” she said.
Hammons is quick to note that many treatments, including SCS therapy, typically won’t work miracles and patients may still experience some level of pain. But the spinal cord stimulator has allowed her to, once again, be an active participant in her life, rather than the bystander she felt to be for many years. For Hammons, that is the true mark of success.
FirstHealth Interventional Pain Medicine provides chronic pain sufferers with thorough evaluations and access to a complete range of pain relief options, including the newest and most advanced back and neck pain treatments. Office locations include Pinehurst, Raeford, Sanford, Troy, Asheboro, Rockingham and Fayetteville. To learn more, visit www.firsthealth.org/pain.
