A Stimulating Approach to Relieve Back Pain without Opioids

As many as one in three Americans suffer from low back pain. Its economic impact is greater than that of heart disease and cancer combined.

Doctors who treat patients suffering from back pain are exploring new approaches that help some patients avoid opioid drugs. The highly addictive prescription painkillers are fueling an epidemic of abuse and overdose deaths.

One opioid-free option available at the Washington University Pain Center  involves stimulating the spinal cord with very short pulses of electricity. Patients can’t feel the electrical stimulation, yet it often effectively can mask the perception of pain.

Spinal cord simulation to relieve pain is not new. It was first introduced many years ago, but older stimulators produce a tingling sensation designed to replace pain with less unpleasant tingling. The newer, high-frequency spinal cord stimulators deliver more energy but without the tingling sensations.

“Patients with back pain have many treatment options, but many don’t get relief after surgery or injections,” said Michael Bottros, MD, Washington University pain management specialist. “Opioids can help some patients temporarily, and physical therapy also helps, but the new-generation stimulators fill an important niche, helping people return to normal activity without pain or the side effects that can result from opioids.”


Deanna Conley, of St. Louis County, had endured back pain for nearly 40 years.

Despite multiple surgeries, she needed a wheelchair to walk any significant distance. “I couldn’t cook a whole meal or even stand at the sink to wash dishes.  I had spinal injections and even saw a pain psychologist.”

In addition, she began to worry about the number of pain pills she took each day. “I was supposed to take one hydrocodone pill at night before bed,” Conley said. “But it got to where I was taking two pills a day and then three, and I worried I might end up being a drug addict at age 77.”

Dr. Bottros determined Conley was a good candidate for a high-frequency stimulator. Studies have shown the devices may be more effective in patients who have had previous back surgery but still have back pain. Research also indicates that although traditional stimulators work well when pain in the back is radiating into arms or legs, the high-frequency stimulators may be more effective when pain is located in the back itself.

“Traditional spinal cord stimulators provide a pleasant sensation in place of pain from sciatica problems or pain down the arm caused by cervical spine problems,” Dr. Bottros explained. “But for people like Ms. Conley, who had already had back-fusion surgery and still had pain, those older devices often aren’t as effective.”

Dr. Bottros inserted electrodes into the area of Ms. Conley’s back where her pain was most acute. The stimulator initially remained outside her back, but after verifying that the approach was having an effect, he used a minimally invasive technique to implant the entire device into the lower part of her back.

Ms. Conley reported a 70 to 80 percent reduction in back pain almost immediately. She is able to walk without assistance for considerably longer distances than she could before the stimulator was implanted, and she even registered for an exercise class.

She’s receiving physical therapy and getting stronger now that she is able to use muscles she couldn’t use previously because of her back pain.

“I feel like I’ve got a whole new lease on life. I’m going to dance at my granddaughter’s wedding!” Ms. Conley exclaimed.


“It’s important that we use a team approach involving doctors, physical therapists and psychologists who help people focus their thoughts on things other than their pain,”  Dr. Bottros said. “Even when a device like this reduces pain, there still is muscle weakness to overcome, so patients need physical therapy to get stronger, to make sure they’re walking correctly and to focus on core stabilization to keep the pain in check.”

“Not long ago, we thought of pain as a symptom of some other underlying disease process,” Dr. Bottros said. “Now we’re learning that pain also may be a disease itself. And in this time of opioid abuse, we must be vigilant in insisting that pain-killing drugs aren’t overused.

Some patients benefit from opioids, but other interventions, combined with a multidisciplinary approach to care, may provide pain management without the adverse side effects and risks associated with opioids.”

For more information about spinal cord stimulation, or to make an appointment with Dr. Bottros, or one of our Washington University pain management specialists, please call:

Pain Management Center
Center for Advanced Medicine
4921 Parkview Place, Suite 14C
St. Louis, MO 63110
(314) 362-8820

Barnes-Jewish West County Hospital
969 N. Mason, Suite 240
St. Louis, MO 63141
(314) 996-8631

Missouri Baptist Medical Center
Pain Management Center
3015 N. Ballas Road
St. Louis, MO 63131
(314) 996-7200