Spinal cord stimulator trial

Important information when going home

Introduction

Your trial of spinal cord stimulation is an opportunity to try to see if it can help you manage your pain. The results of the trial will help you, and us, to decide whether to have a system implanted or not. You will go home after your procedure with the spinal cord stimulation trial system and come back to the pain clinic for planned follow up. We will then discuss with you how the trial has gone. You will be able to telephone the pain clinic during your trial if you have any questions or concerns.

The information below tells you what we do before you go home, what you should avoid doing at home, and what to look for during the trial and what action to take if you think that you have a problem.

Before going home with the spinal cord stimulator - assessment

Before you go home with the spinal cord stimulator the team will make sure that it is working properly and providing stimulation to the area that was agreed. The team will also make sure you understand how to use the patient programmer, and that you are confident to switch the device on and off, as well as change the strength of the stimulation if applicable.

The team will look at your back where the stimulator goes in; to check that the dressing over it is secure and make sure it is clean and not too painful. When you and the team are happy, you will be able to go home with follow-up appointment(s) arranged.

When you are at home

It is important to avoid certain movements and activities when you go home. All the long-term advice with spinal cord stimulators and magnetic fields will apply (see your spinal cord stimulator leaflet to remind you) but in addition there are some other restrictions to be aware of.

The trial spinal cord stimulator means that some of the system such as leads and pulse generator are external to your body. You will have temporary stitches to anchor the wires and lots of sticky tape attached to you to secure them to the pulse generator and to you. This does mean that you will not be able to bath or shower during this time or get any of the areas wet.

Also certain movements and lifting are to be avoided:

• Do not drive
• Do not raise your arms above your head
• Do not twist, stretch or bend at the waist
• Do not lift heavy items, eg nothing above 5lbs/2.5kgs
• Avoid sitting for prolonged periods of time, eg more than an hour
• Be careful you do not catch the leads, make sure these are securely stuck to you with tape and tucked into clothing

Stimulation changes

Stimulation may increase when you sit, lie down or bend slightly backwards. Stimulation may decrease when you stand and vary in intensity when you walk around. We may show you how to change the intensity (feeling) of the stimulation using the patient programmer. If ever you are uncomfortable with the stimulation sensation remember you can always turn it off using your patient programmer.

Complications

Serious complications from having a trial spinal cord stimulator are rare. Disconnection and dislodgement of the electrodes sometimes happen. This will mean that you receive no stimulation. It is not a dangerous situation – turn off the device and contact us.

An infection, a blood clot and neurological damage from an implanted electrode during the trial period are rare complications – which do need rapid attention.

Because the electrode is placed close to the spinal cord, a collection of pus or a blood clot can cause pressure on the spinal cord. This is rare, but if there is pressure on the spinal cord it is crucial to find and treat it as quickly as possible. This must be done by expert hospital doctors to prevent delays in treatment and long lasting damage.

Signs and symptoms to look out for:

• Fluid leaking from the spinal cord stimulator site
• Redness, pus, tenderness, or pain at the spinal cord stimulator wound site
• Feeling generally unwell despite there being no obvious reason
• High temperature or neck stiffness
• Numbness and or weakness in your legs or arms / inability to weight bear
• Difficulty passing water / incontinence of faeces
• A headache that doesn’t improve with your usual treatment
• Important - These problems may happen up to four to six weeks after the spinal cord stimulator is removed.

What to do if you think there is a problem

If you experience any of the signs and symptoms listed above while you have the spinal cord stimulator on trial, you should come to Addenbrooke’s hospital emergency department with this leaflet and your discharge summary.

The on-call neurosurgical team will then be called to assess you and provide the necessary intervention and treatment.

If you have had the stimulator removed and within eight weeks of removal you experience any of the above signs and symptoms, it is important that you contact your GP immediately. Please take this leaflet with you. Your GP will then, if necessary, arrange for you to attend for an emergency neurosurgical assessment at Addenbrooke’s hospital so that you can be examined and further assessed.