Spinal Cord Stimulation (SCS) and Dorsal Root Ganglion Stimulation (DRG) Information for patients
Dorsal Root Ganglion Stimulator Spinal Cord Stimulator page 2 of 12
Stage 1 - Screening trial The following information is to remind you of some of the important points about your stimulator trial and implant. Who do I contact for help or advice after discharge from hospital? For urgent matters after your discharge home on the day of your procedure, or at any other times including weekends and bank holidays, please telephone: Ward N2 at the Royal Hallamshire Hospital on (0114) 271 2891 For non-urgent matters: Please contact the Pain Clinic between 8.30am and 4.30pm on Monday to Friday on any of the following: (0114) 271 5210 (0114) 226 9037 (0114) 271 5795 Reception team Secretary Nurse Base What happens when I am discharged home? During your stimulation trial you will be attending Pain Clinic at the Northern General Hospital to see your Nurse Specialist. You will be given your next appointment before you leave hospital. The first appointment will usually be two days after your procedure. page 3 of 12
How do I look after my wounds? As with any operation, there is a small risk of infection occurring to your wound areas. To try and prevent this we ask that you keep your wounds and dressings dry, as moisture can contribute to the risk of an infection occurring. It is advisable to have a wash rather than a shower or bath as you may be less likely to wet your dressings. If the dressings do become wet it is preferable that they are changed to dry ones and you will be given some spare dressings on your discharge from hospital. As it is unlikely you can reach the wounds on your back, you will need assistance from a relative or friend. If the dressings are changed it is important that the inside of the dressing, which will be placed against your skin, is not touched. Similarly the wound itself should not be touched unless it requires patting dry with a clean towel. If you have any problems with this you can contact the Nurse Specialist in the Pain Clinic on the numbers provided. It is not unusual to have a slight discharge from the wounds, particularly the site where the wire comes through the skin. This could be a mixture of blood and body fluid and may look clear (body fluid), red (blood) or browny red (old blood). What are the signs of a wound infection? Redness The skin surrounding the wound may feel hot Swelling Oozing of green or yellow fluid or pus from the wound If you notice any of the above symptoms it is important that you contact the Pain Clinic or Ward N2 as soon as possible. page 4 of 12
When do my stitches need to be removed? You will need to contact your Practice Nurse to remove these 10 days after your first operation (Stage 1) or 14 days after your second operation (Stage 2). To clarify, the day of the operation is day 0, the following day is day 1 then day 2, etc. If you have had a revision operation to an existing stimulator implant, for example a new lead or battery, these stitches will need to stay in for 14 days. Will I have any pain after my procedure? You may experience pain or discomfort in your back where the wounds are from the procedure. We are hoping the stimulator will begin to reduce your nerve pain but it will not have any effect on the pain from the wounds. You will be given extra pain killing medication to take home for this or alternatively the Consultant may advise you about taking your current medication more often. People s experience of pain after the procedure varies. Some people only feel a bit uncomfortable but others may experience more moderate to severe pain levels. If you are feeling pain this should only last a few days and will start to improve and disappear after a week or two. We would advise you to try and keep moving as your pain levels allow. People often find they begin to feel better if they can resume some activity and feel more normal again. Gentle movement will also help to: Prevent any muscle stiffness occurring Test the effectiveness of your stimulator during the trial period. Prevent the possibility of a Deep Vein Thrombosis (DVT) forming. page 5 of 12
Is there any specific advice about moving? We will have discussed with you previously the importance of movement in relation to preventing your lead from moving. We advise that you follow the activity guidance for 3 months, during which time your lead will settle into place a little more firmly. We advise you of the following: No excessive bending of the spine No twisting movements No stretching up high above your head Do not lift more than 5lbs (2.5kg) What do I need to do during the trial period? It is important that you are able to tell if the stimulator reduces your pain and by how much. It will be useful to be aware of how much your pain is reduced whilst you are wearing the stimulator. Try to notice any other benefits too, such as improvement in sleep or whether movement is easier. It might be helpful to write down any observations or thoughts so you can discuss these with the Nurse Specialist at your reviews. You may find using a pain diary helpful for this and we will provide you with one in a separate booklet. What happens at the end of the trial? You and your Nurse Specialist will discuss the trial period and any benefit that you may have experienced. The extension wire that comes out of your back will be cut by your Nurse Specialist. It will stay in place inside your body until it is removed by the Consultant Neurosurgeon at the next operation. Your experience of the trial will be discussed with the Pain and Neurosurgical Consultants and the decision made as to whether you will benefit from having the full system implanted. page 6 of 12
Stage 2 Full implant What happens if I have a full implant? Approximately 2-8 weeks after the end of the trial you will be admitted to hospital for Stage 2. You will be put to sleep for this stage and you will usually stay in hospital overnight. The wound to the side of your spine will be re-opened and the cut extension lead disconnected from the spinal lead and removed. The spinal lead or dorsal root ganglion lead will remain in position. Depending on which stimulator you will be having, either a new extension lead will be attached to the spinal or ganglion lead and tunnelled under the skin to the abdomen or upper buttock. Alternatively for the MRI safe system, the longer spinal lead will be tunnelled under your skin in the same way. Your Nurse Specialist and Consultant will confirm with you whether or not your stimulator system is MRI safe. The implanted battery will be sited in your abdomen or buttock and connected to the extension or spinal lead. You will then control your stimulator with your remote control as you were able to do in the trial. The remote will connect to the battery through the skin, so no wires are necessary. We will ask you to observe your wounds as you did during the Stage 1 trial. You will need to make an appointment for your stitches to be removed by your Practice Nurse at 14 days after the operation. You will be reviewed in Pain Clinic by your Nurse Specialist a month after your implant. If you do not receive an appointment within a week of your implant please contact the Pain Clinic. If you experience any problems or have any questions you can always ring your Nurse Specialist before your appointment. page 7 of 12
What happens after my first appointment at 1 month? You will be kept under regular review by the Nurse Specialist. Routine appointments are planned for 1, 3, 6 and 12 months after Stage 2 and thereafter at yearly intervals. However, you can always contact your Nurse Specialist for help and advice if needed between appointments. We will also ask you to complete a set of questionnaires at the 3, 6 and 12 month appointments and once a year afterwards. This is to help monitor any benefit or problems you may experience. This will have been explained to you at your initial assessment appointment. What happens if the stimulator does not help? At the end of the trial the extension lead wire will be cut. The Nurse Specialist will discuss your case with the Pain and Neurosurgical Consultants. If it is agreed that you will not benefit from having the full implant you will be admitted 2-4 weeks later for the lead wire and remaining extension wire to be removed. We will ask you to observe your wounds as you did during the Stage 1 trial. You will need to make an appointment for your stitches to be removed by your Practice Nurse at 14 days after the operation. The Stimulator team will decide with you about any further follow up appointments. How do I record my experience of the stimulator trial? We will provide you with a pain diary. You might find it helpful to use this to write down your experience of pain relief or problems during the stimulator trial. When scoring your pain, use a 0 10 scale as you have done previously when completing your pain questionnaires. 0 = no pain and 10 = the worst pain you can imagine page 8 of 12
Please write down your average pain scores that you experienced before having the stimulator fitted. This is so we can compare them to your pain levels during the trial. Least pain:... Average pain:... Worst pain:... Date:... Time:... Pain score:... Stimulator on or off?... Activity: Comments: page 9 of 12
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Produced with support from Sheffield Hospitals Charity Working together we can help local patients feel even better To donate visit www.sheffieldhospitalscharity.org.uk Registered Charity No 1169762 Alternative formats can be available on request. Please email: alternativeformats@sth.nhs.uk Sheffield Teaching Hospitals NHS Foundation Trust 2018 Re-use of all or any part of this document is governed by copyright and the Re-use of Public Sector Information Regulations 2005 SI 2005 No.1515. Information on re-use can be obtained from the Information Governance Department, Sheffield Teaching Hospitals. Email infogov@sth.nhs.uk PD9411-PIL3988 v1 Issue Date: August 2018. Review Date: August 2021