Factors that will influence your doctor's decision to prescribe implantable devices

There are several factors that will influence your doctor's decision, whether or not to prescribe implantable devices to treat chronic back pain. The most important factors will be associated with what other treatments the patient has attempted before being considered for the device, and the patient's willingness to commit to other treatments (such as exercise and physical therapy) while using the implantable device. Typically, patient will have tried several other types of treatments, notable oral medications, physical therapy, and surgery, before either the spinal cord stimulation or the implanted drug infusion pump is considered. Also, the doctor may assess the patient's willingness to commit to other therapies such as physical therapy of back pain exercises while using these types of devices because patient are much more likely to receive benefits of the implantable device treatments if they also commit to a program of strengthening the muscles that support the spine as well. Doctors will consider these factors, among others, when comparing the risks against benefits, before making a decision.



Your symptoms: The severity and type of symptoms you have may indicate which type of implantable device, if any, that a patient would be more likely to benefit from. The doctor will also compare the patient's symptoms with the results of the diagnostic tests available. If the symptoms the patient is experiencing aren't consistent with the results of the diagnostic tests, then the doctor may not have enough information to go on to make a definitive decision as to the proper placement of the device. Usually, physical damage or degeneration to a specific nerve root or section of the spinal cord will suggest back pain symptoms to a specific section of the upper or lower back or section of the body. For example, nerve pain or weakness in a patient's foot should show nerve root compression at the levels of L5 and S2 in the vertebral spine upon X-Ray or MRI. If the radiologic results do not match up with the symptoms, the doctor may be less confident of the proper placement of the electrodes or tubing to deliver the treatment. The doctor may even suspect that the cause of the back pain may not even be as a result of spinal stenosis or a spine problem at all. In those cases, the doctor may want to continue to look for the source of the pain, rather than mask the pain with a device that simply numbs the numbs the patient to pain.

The role of emotions in your pain: Your doctor may consider your emotional management of your pain and condition before considering what the appropriate treatment of your condition is. If your doctors thinks that your pain levels are significantly associated with anxiety or stress, they may decide that an implantable device is unlikely to provide you with significant back pain relief. This type of device is a big commitment to both the patient, and to the healthcare provider, in both the time and money involved to implant and maintain a device, and a psychological evaluation may be required before anyone moves forward with this decision. After the evaluation, your treatment team may decide that a certain type of therapy or relaxation or stress-relief techniques may be preferred over the medical pump/electrical pump type of treatment.