The Kent Centre for Pain Medicine and Neuromodulation: Discharge advice for patients after implantation of a spinal cord stimulator (SCS)

This leaflet will give you advice following discharge from Day Surgery after your procedure. If you have any questions, you should ask your GP or other relevant healthcare professional.

What happens before I go home?

When you are ready to be discharged from Day Surgery, the nurses will check your wound dressing and give you advice regarding your painkillers before you go home.

You will also be given an SCS identity card and SCS product information from the company representative. Please read this and if there is anything that you are unsure about, please ask.

You may feel too drowsy to have the SCS programmed on the day of implant. If this happens you will be given an appointment within a week or two to see the company representative. They will programme your system and give you advice on using the system, including switching between programmes and charging your system.

Can I drive after my procedure?

You must not drive for 24 hours following your procedure; please arrange for someone to drive you home from hospital. It is strongly recommended that you have someone stay at home with you until the following day.

How do I look after my wounds?

• Keep your wound dressing clean and dry.

• The dressing can be removed after five days.

• Please book an appointment with your GP practice nurse to have your sutures (stitches) removed approximately 10 days following your implant.

If you notice any of the following signs, please contact your GP as soon as possible.

• Any leakage from your wound; this may be brown, green, or clear.

• Any redness or swelling at your wound site or around it.

• Persistent pain around your wound sites.

If you have any of the signs and symptoms listed below as a new problem, you must ask for urgent medical attention from your GP. If out of hours you should go to your nearest Emergency Department.

• Prolonged numbness and / or weakness in your legs.

• Any numbness or pins and needles that you did not have before your implant.

• Severe lower back pain.

• Any fever or high temperature, and neck stiffness.

• Difficulty passing urine / incontinence of faeces.

• Severe headache that does not resolve with simple painkillers, such as paracetamol.

When can I return to work?

How soon you return to work will depend on what type of work you do. Generally you are the best person to decide how well you feel and your limitations. Your GP can give you a certificate if you need one for your employer.

Will my painkillers be changed?

You will probably need to continue taking painkillers, at least in the first few weeks whilst your wounds heal and the stimulator is adjusted to get the best pain relief that we can. Your medication will be reviewed when you come to your next appointment with the clinical nurse specialist after your SCS is implanted.

About the stimulator

You may need to add the SCS programmer and charger to your home insurance policy, as we cannot cover costs for accidental damage or loss. We suggest that you contact your home insurance provider for advice.

The stimulator may be affected by strong magnetic fields. If you see a sign warning people with heart pacemakers to report to staff, this will also apply to you. Stimulators may activate airport detectors and anti-theft devices in some shops, and may even be affected by some mobile phones if they are held over the device. These, along with strong magnets, may turn your stimulator off and affect your battery.

There are a number of medical treatments that should be avoided with your SCS, for example: Diathermy (heat treatment), Lithotripsy (treatment for renal stones), and radiation therapy. If in doubt, please contact the Pain Clinic for advice.

Some SCS systems are not MRI conditional and you will be advised to avoid MRI scans of your body. However, you will be able to have CT (computerised tomography) scans, ultrasound scans, and x-rays.

Guidance on physical activity following the insertion of a Spinal Cord Stimulator (SCS)

• You should avoid any strenuous activities for at least one day after your procedure. However, you should start normal activities again as soon as possible.

• You may feel tender around your implant sites, so make sure you take regular painkillers (such as paracetamol) to help with any discomfort.

• You will be contacted by the clinical nurse specialist for a telephone review around two weeks after your implant, to check that everything is going well. Please contact the Pain Clinic or Day Surgery if you need further advice before this review.

• The following information is a general guide only and should be in line with your consultant’s recommendations.

For approximately the first 10 days after your full implant or until your sutures / dressings are removed.

• In order for you to fully see how well your SCS is working during this time, we encourage you to move about as normally as possible, including standing, walking, and climbing stairs.

• There are a few key movements that you should avoid, so you do not move the SCS leads (Bending, Lifting, Twisting, Stretching, or the ‘BLTS’).

  • Avoid bending your back all the way forward (such as touching your toes).

  • Avoid bending your back backwards.

  • Avoid fully twisting your spine (this includes turning your head all the way round if you have an upper stimulator for neck pain).

  • Avoid raising your arms up above your head, and your elbows above your shoulder.

• We advise that you do not drive during this time.

• You must not have a bath or shower following the full implant, until your sutures / dressing have been removed. This is to keep your wound dry while it heals, to reduce the risk of infection.

The first six weeks after a full SCS system implant

In order to keep your body healthy and to help your tissue to heal, it is important that you remain gently active. During this time you can gradually return to the activities that you may have avoided in the past due to your pain.

However, you should continue to avoid extreme bending and twisting of your back, turning your head right round (for upper stimulators), and elevating (raising) your arms above shoulder height for at least six weeks (see ‘BLTS’ on page 3). The following points provide more specific guidance.

• Lifting and carrying

  You can lift and carry items but for the first two weeks try to avoid lifting anything heavier than the weight of a full kettle. Over the following weeks you can build this up gradually. By six to eight weeks you can progress to carrying heavier items such as two large shopping bags. If your work involves heavy lifting, ask for advice from a member of the neuromodulation team.

• Driving

  You can begin driving again during this phase. However, please note that some SCS devices / programmes need to be switched OFF when you are driving. Check with your neuromodulation team before driving.

  Do not drive until you feel you can safely do an emergency stop and you are no longer taking medication that would affect your driving (check with your specialist nurse if you are not sure). We would also advise you tell your car insurance company about your SCS.

• Sex

  You can have sex again once you feel able. Take care to avoid fully twisting and bending your spine.

From six to eight weeks after a full SCS system implant

By six weeks scar tissue will have started to form around the leads, anchoring them in place so you can begin gently bending and twisting your spine.

Gradually increase any activities at a pace that is comfortable for you.

From 12 weeks and onwards

The leads will now be fully anchored in place, so you can return to all your normal activities (at a comfortable pace). However, there are a few things that you must continue to avoid in the long term.

• Contact sports, such as rugby, boxing, and judo.

• Extreme sports, such as bungee-jumping and parachuting.

• Scuba diving beyond the depth of 30 metres.

• High g-forces, such as roller-coasters.

• Manipulation of your spine from physiotherapists, doctors, osteopaths, and chiropractors.

• Operating power tools with the SCS switched ON.

• If using welding machinery, please do not go within 2 metres of the power unit and 1 metre of the weld site, whether you have your stimulator switched ON or OFF.

• You must continue to turn your device off when driving unless you have been told otherwise by your neuromodulation team.

Further information

If you have any concerns regarding the information in this leaflet or your procedure, please phone the Pain Clinic.

Kent Centre for Pain Medicine and Neuromodulation (direct lines)

• Kent and Canterbury Hospital, Canterbury
  Telephone: 01227 783049

• Queen Elizabeth the Queen Mother Hospital, Margate
  Telephone: 01843 235094

• William Harvey Hospital, Ashford
  Telephone: 01233 616691

Useful information

For further information on SCS and to see a list of other East Kent Hospitals pain leaflets, please see the links below.

• East Kent Hospitals. Chronic pain patient information

• British Pain Society (2009). Stimulating the spinal cord to help with pain: information for patients. April 2009

• National Institute for Health and Care Excellence (NICE). Spinal cord stimulation for chronic pain of neuropathic or ischaemic origin. 22 October 2008.