Feb 26, 2021

Patients dial down chronic pain with spinal cord stimulation

Enhanced technology offers an effective alternative to opioids and nerve blockers

David Belovich finally feels like he’s getting a step ahead of the debilitating pain that has dominated his life for close to 40 years.

After relying on heavy doses of opioids and trying a long list of other treatments to cope with excruciating back and leg pain for decades, the Ottawa native has at last found relief with spinal cord stimulation (SCS) – a medical technology that delivers mild electrical pulses to interrupt pain signals before they reach the brain.

While the technology has existed for more than 50 years, it has undergone significant advances over the past several years that allow physicians to better target pain impulses, treat pain stemming from more medical conditions and make it much more user-friendly for patients.

Desperate to find a way to manage his worsening pain, Belovich, 57, underwent surgery at Toronto Western Hospital in 2017 to have a spinal cord stimulator implanted in his back.

He noticed almost immediate improvements. The tiny device has cut his pain levels to about half, allowing him to get back to work, enjoy his passion for scuba diving and reclaim his life with his wife and children.

“It’s quite a godsend. It’s hard to explain the impact to somebody who hasn’t experienced chronic pain,” says Belovich, a retired Colonel with the Canadian Armed Forces and presently a public servant. “This is life-altering for somebody who’s living with chronic pain.”

The pain specialist who implanted Belovich’s spinal cord stimulator – Dr. Anuj Bhatia, Director of Chronic Pain Clinical Services at University Health Network – hopes to see the provincial government increase funding to hospitals to allow more people with chronic pain to benefit from spinal cord stimulators.

Currently, hospitals across Canada are not receiving enough funding for this procedure to meet the high demand among pain patients who could potentially benefit from the technology.

Dr. Bhatia has seen firsthand the important role spinal cord stimulation can play in weaning certain people living with chronic pain off potentially dangerous opioids and also serve as alternative to expensive and controversial nerve blocker injections that typically offer only short-term pain relief.

“I think right now we are living in the golden age of spinal cord stimulation. There are so many more options available to patients, even in terms of a single device,” Dr. Bhatia says. “There is a growing body of research that shows cost effectiveness of spinal cord stimulation within a year of an implant because the cost of other pain therapies is so high, including loss of your productivity to society.”

After initially injuring his back in a military training exercise in 1982, Belovich’s condition became progressively worse over the years. Resulting damage to his sciatic nerve left him with severe pain that affected his mobility, his ability to work at times and his overall mental health.

The spinal cord stimulator allowed him to concentrate more being productive through work and enjoying his life, instead of focusing all of his energy on pain.

While Belovich still uses opioids occasionally to dull spikes of pain, he finds that spinal cord stimulation has enabled him to wean himself off heavy doses of medication that clouded his mind and made it difficult for him to work.

“When you’re on large quantities of morphine, you’re just not there all the time. You can’t focus. You can’t think strategically or long-term,” he says.

Other chronic pain patients found similar relief with spinal cord stimulation.

Rubin Samaroo, 63, of Toronto has been dealing with severe pain for nearly five years after a nearly fatal heart attack set off a number of related medical problems. Resulting damage to his sciatic nerve left him with severe pain in his right leg and nearly immobile. Although he avoided opioids because he was worried about their potential side effects, he had regular pain blocker injections, but found their numbing effect wore off quickly.

Samaroo had a spinal cord stimulator implanted in his back at Toronto Western Hospital in 2019. The device has helped cut his pain levels by about 65%, allowing him to get out of his bed, get back on his feet and enjoy life again.

“I still have some difficulty walking, but it’s my intention to run once more,” he says. “If I can hold a walker and run with it, that would be my dream.”

Liz Malthaner, 54, of Kitchener, has dealt with chronic back pain for more than 30 years. Surgery a decade ago to fuse discs in her spine ultimately led to scar tissue that damaged her sciatic nerve and caused her pain to worsen. She relied on various medications to cope with her pain, but didn’t like how they clouded her mind, making it difficult for her focus.

She had also seen the damaging impact that opiods can have on some people, including a late brother who became addicted to them after using the drugs to cope with his own chronic pain.

“Opioids felt like they never really took care of the pain. They just made you not care,” she says.

She tried nerve blocker injections for a period of time, but gave up on them because they offered only short-term and sporadic relief. “I’d get a month or two of relief and then pain would be back,” she says.

A spinal cord stimulator implanted in her back by Dr. Bhatia last October has dramatically reduced her pain. She has returned work full-time, the depression she had while trying to manage her pain has lifted and her outlook is positive again.

“It’s night and day for me. I’ve had tremendous success with it. I have the odd day now when it doesn’t quite cover the pain from my leg, but otherwise I go about life as I never had pain,” she says.