Managing Back Pain Without Surgery

Marlene “Kay” Roesener’s pain from arthritis made her a perfect candidate for a spinal cord stimulator. She sought treatment with Dr. Joshua R. Wellington at IU Health’s Advanced Pain Therapies Clinic.

Marlene “Kay” Roesener had once enjoyed sitting on the bleachers watching her grandchildren’s ball games, sailing on the open water, gardening and golfing. But over time, every day pleasures became painful tasks. She was diagnosed with scoliosis and Parkinson’s disease and developed arthritis in her back.

“We like to go to Florida but even walking in the sand was difficult. Swinging a gulf club was painful,” said Roesener, 75, who is married to Ed Roesener. “Back surgery wasn’t really an option because the arthritis had caused deterioration of my bones.”

When she first sought treatment with Dr. Joshua R. Wellington at IU Health’s Advanced Pain Therapies Clinic, she described the discomfort at a level “8” on a scale of 1-10.

“I had a family history of arthritis and the pain was so severe that I wasn’t enjoying the things I love to do,” said Roesener. “Now I tell people, there are options to help control that pain and it doesn’t have to be pain meds or major surgery. I feel so much better.”

Spinal cord stimulation became a viable option and Roesener was an ideal candidate. Essentially spinal cord stimulation therapy uses electrical pulses to block pain signals before they reach the brain. It involves passing special insulated wires, called leads, into the spine and attaching them to a small electrical stimulation device implanted in the lower back.

The cutting edge procedure is a two-step process. The first step involves placing trial electrodes into the epidural space of the spine. This allows the pain signals to be blocked with electricity. The trial typically lasts about a week and allows the patient to feel the level of pain relief, gain functional improvement and assess the overall changes in quality of life. If the trial is a success then the temporary electrodes (leads) are removed, and permanent electrodes and a battery are implanted soon after, just under the skin in the small of the back.  

“The trial placement of the leads is not a surgery. It’s a try it before you buy it type of procedure. It’s one of the few types of procedures in medicine that you can try out to see how it works, “ said Dr. Wellington, who teaches the procedure to physicians across the country. “You can’t do that with back surgery.”

Once the success of the trial is determined, the permanent electrodes along with a battery pack are placed just under the skin in the small of the back.

More about the procedure:

Who is the right candidate for spinal cord stimulation: Patients with chronic back and leg pain who have had failed back surgeries or who want to avoid surgery and continued pain medication. Patients undergo psychological evaluations and trial procedures before the final implantation of the device.

How long does the procedure take to complete: 

The procedure is typically performed in a hospital or clinic outpatient setting with a local anesthetic used to numb the skin around the lower back area. The trial usually takes about 30 minutes and the implant takes about 1-2 hours.

How long do the implanted electrodes last? 

Other than replacing the batteries in the simulation device (about every 10 years), the electrodes can last a lifetime.  Patients schedule annual check ups to evaluate the success of the procedure and pain levels.

— T.J. Banes,