This information leaflet has been designed to answer any questions that you might have after insertion of your Spinal Cord Stimulator (SCS) system. It provides information on what will happen immediately after your discharge from the hospital and advice about how to gradually increase your physical fitness and ability to do more over time.
Discharge advice following a Spinal Cord Stimulator (SCS) implant
Once the SCS battery has been implanted and the nursing staff are happy with your postoperative recovery you can be discharged home. It is important that you have an adult to drive you home after the surgery and to remain with you overnight as you will have had sedation for the procedure.
You may have some questions regarding the care of your surgical wound and what you can or cannot do when you have been discharged home. This next section aims to answer some of the most asked questions. If you need any further advice please contact the Pain Centre between the hours of 8am and 4pm Monday to Friday. If you feel unwell or have concerns about your surgical wounds outside of these hours then please go the Salford Royal Accident and Emergency department and inform them that you have had your SCS implanted at the Manchester and Salford Pain Centre.
Contact numbers are given at the end of the leaflet.
Do NOT go to your local accident and emergency department as they will not be able to assist you as this is a specialist treatment.
About the Spinal Cord Stimulator (SCS)
We will switch on your SCS while you are in the Day Surgery Unit. You will be given instructions and advice on the day as to how you can best use the system.
You will be given a handbook from the SCS company relevant to your device which will explain how to use the equipment. If there is anything that is unclear please do hesitate to ask one of the pain specialist nurses.
If you have any questions following the programming of your SCS system, please ring the pain specialist nurses at the Pain Centre for advice and they will get back to you at the earliest opportunity.
How do I look after my wound?
Please contact the Pain Centre (0161 206 4002) for advice if you feel unwell or develop any redness or swelling around the wound indicating an infection. If you have stitches in place which are not absorbable we will remove these from your wound when you attend a follow-up appointment at the Pain Centre. If it is more convenient for you to have this performed by a practice nurse at your local GP surgery then this can be arranged.
Do I stop any of my pain medication during the trial and after the battery is inserted?
You will need to continue taking your regular pain medications, at least until after the completion procedure. It is normal to experience some acute pain at the site of your operation for a few days after the procedure. Make sure you take your regular pain medications on the day of the procedure. The site of the operation may continue to be painful for a number of days. You may need to take additional pain medications to help with this new pain in addition to your usual pain medications. You will only require this for a short period of time, whilst the healing takes place and you become more active. A member of the Pain Team will review your current analgesia and offer advice or prescribe some additional analgesics.
What about work?
How quickly you return to work depends on the type of work you do and how clean the environment you work in is. You will be restricted from lifting heavy objects, doing excessive stretching, and bending movements for approximately six weeks. It is important to remember not to put the epidural wire at risk during the trial period through excessive movement or situations that predispose to infection.
Generally, you are the best person to decide how you feel, and knowing your limitations will influence your decision. You may want to discuss this with the team before you are discharged home. The doctor can issue you with a fitness to work form if required.
What about driving?
We suggest you commence driving once the postoperative pain has settled; this may take up to two weeks. You must be able to safely perform an emergency stop before you start driving again. More information can be obtained from the DVLA.
Returning to activities after a SCS implant
This section provides information on what you can and cannot do in the first few weeks after having your SCS implanted. It also contains important advice on how to pace your activities, good posture and lifting techniques. If you encounter difficulties with returning to your desired activities you will find more information towards the end of this section about the rehabilitation support that is available from the Pain Centre.
The effect of chronic pain on activity levels and fitness
People with chronic pain frequently cut down on their activities and avoid doing things which make them feel worse. A reduction in activity leads to muscle weakness and stiffness and most people with chronic pain notice a general reduction in their fitness over time.
While you will have likely gained some good pain relief from your SCS, your muscles and joints will still be weaker than they were before your pain began. It is important therefore that you slowly build up your fitness again using a graded and paced approach.
Many people with chronic pain also report a loss of confidence and it is common to be concerned about what you can safely do now your SCS has been implanted. For the first six weeks there are some recommended restrictions on how much activity you should do but after that time most people are able to pace up their activities and exercise. Your SCS Team will guide and support you through this process and are happy to answer any questions you may have along the way.
How to pace yourself
Most chronic pain varies in intensity over the course of days or weeks. Basing what you do on how you feel can result in overdoing things on a good day and underdoing things on a bad day. This is called over and under activity cycling.
Pacing describes balancing the day’s activity so that the day is divided into periods of rest and activity. It will help you to manage the day better and, by keeping to your planned target, means that you and not your pain will decide how much you do.
Now that your SCS has reduced some of your pain, you may be tempted to do more than your muscles and joints are ready for. It is important that you build up slowly and gently over a number of months. To do this you will need to pace yourself and set small, achievable goals. It is important to take rest breaks before you feel over-tired, or your pain increases to very high levels.
It is helpful to work out your current tolerance level or time limit for each activity you plan to do. This means working out how much of the activity can be done now without overdoing it (initially this may have to be an educated guess). Make this level a target that you stick to and do not do more than your target for that day. Once you can confidently achieve your set target on a consistent basis and when you feel ready, you can slightly increase your target over time.
Good posture and the alignment of the spine
Developing a good posture needs to be a habit. The better your posture, the more your muscles can work efficiently without getting painful and tired. In addition, ligaments and other soft tissues are at their best length. The spine has gentle natural curves.
Typically, there is a gentle curve inward at the level of the neck, a curve outward along the middle of the back and then a gentle curve inward in the low back. This position is the ideal alignment of the spine and is often referred to as spinal neutral or the neutral position of the spine.
Moving carrying and lifting
During the first few months after having your stimulator implanted you will be asked to limit how much you lift. When you are lifting it is important to follow some key points:
Prepare….
- Have a good base of support – have your feet placed apart and firmly on the ground
- Keep as close as possible to the object you are lifting
- Bend your knees and hips and keep your spine in the neutral position
- Get a good grip on the item you are lifting
- Brace your abdominal muscles. …. and lift
- Lift slowly and do not jerk
- Use your legs
- Lift in a straight line
- Turn using your feet rather than twisting your back
What types of activities can I do and when can I start to do them?
Days 1-10 after your SCS has been implanted
- It is good to change position regularly to avoid stiffness, improve your circulation and maintain function. Use cushions to support you while you are sitting and do not slump. Do not sit still for prolonged periods of time. Get up regularly and have a walk around within your tolerance level
- Keep your spine in a neutral alignment and avoid bending. If you have a SCS for neck and arm pain you also need to avoid turning your head all the way round to look over your shoulder at present
- You can climb the stairs as often as you feel comfortable to. You may need to hold on to handrails and take it more slowly to begin with
- Do not lift your arms above the level of your shoulders. You will need to adapt how you get washed and dressed during this time and you may need a bit of help from someone else to begin with. When you are brushing your hair or putting on an overhead piece of clothing you will need to keep your elbows low
- During this early stage only lift or carry items which weigh less than 2kgs such as a kettle half-filled with water or a 2 pint bottle of milk. Try to move smoothly and evenly
- Try to maintain a daily routine which involves getting up and going to bed at a regular time
Day 10 to week 6
- Avoid lifting your arms above your head. Bend your arms and keep your elbows at shoulder height or lower when dressing or washing your hair
- Start to pace up light to moderate activities which you can do without significant bending and twisting
- Slowly pace up the amount of time you can walk, sit and stand for. Follow pacing principles and prioritise and plan your activities so that you can be active without pushing yourself too much and over-doing it. Pace yourself and split tasks up into smaller jobs. Break up periods of gentle activity with regular rest breaks
- You can now start to build up your tolerance for lifting and carrying objects which weigh up to 5kg
- Driving can be resumed when you can safely and confidently perform an emergency stop and when you are not taking medications which impair your ability to drive. More information can be obtained from the DVLA
More than 6 weeks after implantation
- You can now slowly return to full spinal movements. You can do activities which involve stretching above your head and activities which involve controlled bending
- You can start to carry and lift heavier objects that are within your tolerance level. Follow good moving and handling techniques. If your lifestyle involves very heavy lifting please consult the SCS Team for more advice
- Gradually build up your fitness by pacing up light to moderate activities. Gentle stretching and strengthening exercises are encouraged to rebuild your flexibility and strength. You can now start exercises such as swimming. You will need to follow a gradual pacing up plan for returning to activities and sports, especially if you are building up to returning to activities you have not done in a very long time
- You may have specific goals you are working towards which involve more complex activities and movement patterns such as DIY, heavier housework, dancing, sports and caring for children or others. You might find it helpful to gain extra support and advice from a physiotherapist to regain your fitness and confidence with these activities
In the longer term
If all is going well, continue to slowly build up your function and work towards realistic and rewarding goals. We suggest that you avoid contact sports such as rugby and judo although you can still participate in some of the non-contact training for these types of sports. It is also advisable to avoid activities which carry a high risk of falling or breaking your SCS leads such as parachute jumping, trampolining and vigorous amusement park or fairground rides. All spinal mobilisations/manipulations are contraindicated for the life of the SCS being in situ.
If you feel that you are struggling to return to activities which are important and personally meaningful, you can ask for more support from the Pain Centre Rehabilitation Team. Even when people get an excellent result from their SCS, returning to usual activities can be difficult. Your pain is likely to continue to fluctuate in intensity and you can still have good days, bad days and flare-ups of your remaining chronic pain. You are likely to have lost some of your fitness and confidence since your chronic pain began and your pain may still be affecting your mood, sleep, social life, work life and relationships.
The Pain Centre has a team of specialist physiotherapists and clinical psychologists who help people with chronic pain to develop strategies to cope and manage with their pain. They provide rehabilitation programmes which could potentially help you to further reduce pain-related disability and distress and improve your quality of life. If you would like to explore further rehabilitation options at the Pain Centre please speak to your SCS Specialist at your review appointments.
My rehabilitation goals
Prior to meeting with a member of the Pain Centre Rehabilitation Team it is helpful to consider what you would like to work towards achieving. What do you hope to achieve both physically and psychologically? If you had a psychology assessment prior to your SCS implantation, you may have considered these things already.
Remember that rehabilitation cannot cure chronic pain. The focus is to reduce the negative impact that pain can have on areas of life such as physical function, mood, sleep, social life, work life and relationships. Rehabilitation work with chronic pain specialist physiotherapists and clinical psychologists can help you to:
- Increase your strength, flexibility and physical function
- Improve your sleep
- Learn how to relax
- Manage worry and low mood
- Learn new ways of thinking through problems
- Reduce reliance on medication
- Achieve goals to improve your quality of life
Use the space below to write down what you would like to work on. It would be helpful to bring this list with you to your rehabilitation assessment appointment.
Contact Names
Professor Abdul Ghaaliq Lalkhen, Consultant in Pain Management and Anaesthesia
Dr Mahindra Chincholkar, Consultant in Pain Management and Anaesthesia
Mr Julian Evans, Consultant Neurosurgeon Mrs Sue Barnes, Consultant Nurse
Robin Wilding, Specialist Pain Nurse Grace Richardson, Administration
Contact Numbers
Pain Centre
Monday to Friday 8am - 4pm – 0161 206 4002
Email: Painreception@nca.nhs.uk
During weekends and out of office hours we ask that you go to Salford Royal Hospital, Emergency Department where the Neurosurgical On-Call team will be contacted with regards to your stimulator.
Please show either this leaflet, or the SCS information card that you were given to the doctor who sees you in the Emergency Department.
Date of Review: December 2023
Date of Next Review: December 2025
Ref No: PI_N_1874 (Salford)