Download What is Nevro™ spinal cord stimulation?

National Hospital for
Neurology and Neurosurgery
National Hospital for Neurology
and Neurosurgery
Nevro™ spinal cord stimulation
Pain Management Centre
If you would like this document in another language or
format, or require the services of an interpreter, contact
us on 020 3448 2380. We will do our best to meet your
needs.
Contents
What is Nevro™ spinal cord stimulation?
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How can Nevro™ spinal cord stimulation help?
What alternative treatments are available?
What will happen if I decide not to have this
procedure?
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What are the risks of Nevro™ spinal cord stimulation?
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Safety and Precautions
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Short-wave diathermy
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Asking for your consent
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How should I prepare for this procedure?
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Implant programme
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What happens during this procedure?
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What should I expect after this procedure?
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Where can I get more information?
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Contact details
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Where to find us
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This booklet has been written by the Pain Management
Team at The National Hospital for Neurology and
Neurosurgery. It is intended for patients (or their family or
carers) who have been referred to our service and may be
offered this procedure. It is not intended to replace
discussion with your consultant.
If you have any questions about Nevro™ spinal cord
stimulation, please do not hesitate to contact a member of
our team. They will be happy to answer them for you.
What is Nevro™ spinal cord stimulation?
Spinal cord stimulation (SCS) systems have been in use for
more than 30 years to treat chronic pain. It works by
delivering mild electrical impulses that interrupt pain signals
to the brain, and replaces them with a tingling sensation that
covers the specific areas where pain is perceived. SCS has
been used to treat a wide range of chronic pain conditions,
such as failed back syndrome, neuropathic (nerve) pain and
complex regional pain syndrome.
In 2011 Nevro™ SCS system was introduced and is the first
SCS system that can treat chronic pain without the need for
the patient to feel the tingling sensation. The Nevro™
system has also been shown not only to treat limb pain but
to reduce low back pain.
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How can Nevro™ spinal cord stimulation help?
You may experience improvement in your pain symptoms
and quality of life. You may feel more able to function and
participate in activities of daily living. It may also be
possible for you to take less pain medications.
What alternative treatments are available?
SCS is usually reserved for patients who have severe
chronic pain that is limiting their daily activity and who have
already tried all reasonable, more conservative therapies.
The pain management centre offer treatments which include
a variety of injections, psychological approaches,
physiotherapy, TENS (transcutaneous electronic nerve
stimulation), medicines and acupuncture.
We are happy to discuss your options in detail to help you
choose the best treatment for you.
What will happen if I decide not to have this procedure?
The decision to go ahead with this treatment is entirely
yours. If you choose not to proceed we will discuss other
treatment options and the management of your symptoms
with your doctor. This will not affect further treatment in any
way.
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What are the risks of Nevro™ spinal cord stimulation?
All treatments and procedures have risks and we will talk to
you about the risks of this procedure. We do not have the
exact percentages for these risks but we can group them
into common, less common and very rare.
It is common to feel some minor discomfort after the
procedure which may require a short course of pain killers.
Less common risks include:
 Painful battery or connection site. If this is severe, further
surgery or removal of system may be advised.
 Infection. If this happens, the whole system may need to
be removed.
 Bleeding, which may lead to minor bruising and in very
rare cases may require further surgery.
 It is possible to puncture the membrane around the spinal
cord during the procedure causing a leak of fluid which
can result in severe headaches. These headaches
generally get better once the leak is sealed but may
require further treatment in rare cases.
 The leads may move or stop working. This may require
another operation to replace the lead.
 You may feel stimulation outside the area of pain, but this
is only a problem if unpleasant.
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 Failure to capture the area of pain, or no pain relief, which
may lead to consideration of further surgery to re-site the
leads or remove the system.
There are other problems which are very rare but more
serious. These include:
 Needle damage to the spinal cord or nerves.
 Bleeding and compression of the spinal cord. This can
result in nerve damage which may be permanent and very
difficult to treat effectively.
Not everyone responds to SCS in the same way and your
experience may vary. It is important to understand that
spinal cord stimulation is not a cure for your pain, but may
help you to manage your pain more effectively and improve
your function.
Safety and Precautions
You should always carry an ID card that will be provided by
the hospital once you have the stimulator implanted.
Once you have a stimulator device implanted there are
some things you should know about that may affect the
device.
Some types of body scanners can interfere with your spinal
cord stimulator. Generally, you should not have an MRI
scan. Normal x-rays and CT (computerised tomography)
scans are generally safe. Other scanners in airports and in
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some shops can also change the settings of a spinal cord
stimulator. In general, any sign that gives a warning for
people with heart pacemakers also applies to people with
spinal cord stimulators.
Short-wave diathermy
Some health care professionals, such as physiotherapists,
use a treatment called ‘short-wave diathermy’. This
treatment can be dangerous for people who have a spinal
cord stimulator.
If at any time you develop a problem with your spinal cord
stimulator or have any concerns you should contact the pain
management centre.
Asking for your consent
We want to involve you in all decisions about your care and
treatment. If you decide to go ahead with this procedure, by
law we must ask for your consent and will ask you to sign a
consent form. This confirms that you agree to have the
procedure and understand what it involves. Staff will
explain all the risks, benefits and alternatives before they
ask you to sign a consent form. If you are unsure about any
aspect of your proposed treatment, please don’t hesitate to
speak to a senior member of staff again.
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How should I prepare for this procedure?
If you and your pain doctor decide that this is the right
treatment option for your pain they will enter you onto a care
pathway.
You will first be seen by a medical doctor who will determine
whether your pain is suitable for spinal cord stimulation.
Once you have decided you would like to have this
treatment you will be entered into an implant patient
programme.
Implant programme
The programme is designed to:
 Provide you with information on the procedure and
potential risks and benefits
 Increase your understanding of chronic pain and spinal
cord stimulation
 Increase the effectiveness of spinal cord stimulation
treatment
 Work on maximising your physical fitness and function
 Help you to work to realistic goals
 Maximise psychological well being
 Help you meet other patients who have similar
experiences
 Provide support in decision making
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 You will also have the opportunity to learn about the
components of the system and what they look like.
Once you have completed the implant programme you will
be put on the waiting list for the procedure, and you will be
contacted when a date becomes available. You will then
also be assessed by the Pre – operative Assessment
Centre team prior to coming into hospital to prepare you for
the procedure.
You will be asked to stop any blood thinning medication
such as warfarin, aspirin, and clopidogrel. The pain
management nursing team will advise you of alternatives to
these medications in the event that you need to continue
with these treatments. Please do not stop any medications
until you have been advised how and when to do so.
You will need to fast before this procedure. You should not
eat for at least six hours and have nothing to drink for up to
two hours beforehand. As this procedure is usually a day
case admission you will be asked to bring someone with you
to make sure you get home safely. Alternatively you may be
admitted into hospital for a stay of one or more nights.
What happens during this procedure?
The spinal cord stimulator system will be implanted in a
theatre environment using x-ray guidance. The procedure
can be done under sedation and with local anaesthetic, or
under general anaesthetic. A small incision will be made in
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your back to implant the lead under your skin in the epidural
space. Another incision will be made in either your
abdomen or buttock depending on which site you choose for
your battery to be implanted. The battery will be positioned
under your skin.
After the procedure you will spend a short time in the
recovery room before going back to your ward.
When you are fully awake a specialist pain nurse will teach
you how to switch your stimulator on and off. The nurse can
also use a special computer to programme your lead to
deliver the stimulation to the right area of pain. When you
are fully recovered you will be allowed to go home. Most
patients will be able to go home on the day of the
procedure. If the procedure is scheduled for the afternoon
you may be required to stay in hospital overnight.
What should I expect after this procedure?
When you get home after the procedure you should rest for
the day. Do not attempt to drive, or go to work. You should
aim to limit the amount of bending and twisting you do. This
will reduce the risk of the lead moving out of place.
It usually takes up to three to six weeks for the lead to be
fully secure, but you will be able to move around freely as
long as you are careful not to bend to pick things up or turn
or twist your back. You should also avoid heavy lifting.
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Any suture or clips can usually be removed in ten days time
following the surgery. This can be done by your GP or
practice nurse.
If you notice any redness or swelling around the wound site
or near to the implant you will need to contact us as soon as
possible. This may require further assessment and in some
cases a course of antibiotics if an infection is present. You
will need to see your GP first and then contact the Pain
Management Centre during working hours Monday to
Friday, 9am to 5pm. Outside normal working hours you
should visit your local accident and emergency (A&E)
department.
If your stimulator stops working or require advice concerning
the stimulator, you can contact one of the specialist nurses
who will see you in normal working hours.
Ongoing care
You will be seen by a specialist nurse in clinic six weeks
after the insertion of your stimulator. The first appointment
will be to check the wounds have healed and that the spinal
cord stimulator is working at an optimal level.
Regular follow-up is necessary to ensure that the spinal
cord stimulation continues to work effectively and also to
measure the battery life.
You will also attend the group sessions at three months, six
months and 12 months.
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If your stimulator stops working or require advice concerning
the stimulator you can contact one of the specialist nurses
who will see you during normal working hours.
Where can I get more information?
British Pain Society
Information about spinal cord stimulation for the
management of pain: recommendations for best clinical
practice. www.britishpainsociety.org
UCL Hospitals cannot accept responsibility for information
provided by other organisations.
Contact details
The Pain Management Centre
The National Hospital for Neurology and Neurosurgery at
Cleveland Street
25 Cleveland Street London W1T 4JA
Direct Line: 020 3448 4776
Switchboard: 0845 155 5000 / 020 3456 7890
Fax: 020 3448 3511
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Where to find us
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Space for notes and questions
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Publication date: June 2016
Date last reviewed: June 2016
Date next review due: June 2018
Leaflet code: UCLH/NHNN/PM/NEVRO/1
© University College London Hospitals NHS Foundation Trust 2013
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