More than 26 million Americans between the ages of 20 and 64 experience frequent back pain, which is the leading cause of disability in Americans under 45 years of age, according to the National Pain Foundation. Finding relief for the chronic pain sufferer continues to be a challenge for physicians. Srinivas Mallempati, MD is a Physical Medicine and Rehabilitation physician who completed his fellowship training in pain medicine and spine intervention and is now practicing at Alabama Orthopedic Spine and Sports Medicine Associates at St. Vincent's East Hospital. As Medical Director of the Rehabilitation unit at Trinity Medical Center, Mallempati says that he follows a basic treatment protocol for all of his patients with back and neck pain that first involves the use of analgesics and physical therapy to relieve pain. "If the patient still has pain and depending on what the imaging studies show, we use injections and blocks to relieve the discomfort," he says. "If the imaging studies reveal pathology that would benefit from surgery, we refer the patient to a surgeon." For back and neck pain, epidural blocks and facet blocks are effective. "We do a discogram to find which disc is causing the pain. It primarily helps the surgeon to localize one level for surgery. We sometimes place steroid and numbing medicine in the disc or joint," Mallempati says. "In facet joints, we inject into the joint or block the nerve. If the patient responds to these blocks, we do a confirming second block to make sure we get the same response." When the patient responds well to a second block, Mallempati uses radiofrequency thermocoagulation to "burn" the nerve that carries the pain to the spinal cord. The procedure actually involves the passage of current from an electrode placed along the nerve which heats and destroys the nerve. "Patients usually get longer relief with this procedure as it takes the nerve at least six to nine months to regenerate," Mallempati says. When all of these treatment regimens are tried and a patient still has back pain, Mallempati typically refers the patient to a surgeon for a surgical opinion. However, even surgery can fail for some patients, leading to Failed Back Surgery Syndrome (FBSS). FBSS generally is defined as pain continuing or resuming despite an operative procedure undertaken to correct the cause of the pain, according to the Neuromodulation Therapy Access Coalition. The coalition is comprised of the American Academy of Pain Medicine, the American Society of Interventional Pain Physicians, and the International Spine Intervention Society. For patients suffering from chronic back pain and FBSS, spinal cord stimulation (SCS) may provide the relief they could not get through traditional methods. SCS has been in use for more than 40 years and has helped more than 100,000 patients worldwide who experienced intractable severe pain despite exhausting all other methods of pain treatment, including surgical procedures and the use of powerful analgesics and pain medications, according to the Neuromodulation Therapy Access Coalition. SCS uses low voltage stimulation of the spinal nerves to block the feeling of pain. Initially a trial treatment is performed where a temporary lead is placed in the spine and connected to a battery in a belt that the patient wears. If the patient responds well, then the lead is replaced with a permanent one. A small lead carries the shocks from a battery implanted in the abdomen or buttock to the nerve fibers of the spinal cord that are causing pain. When stimulated it feels like a slight tingle. "The pain is reduced because the mild electrical shocks interrupt the pain signal to the brain," Mallempati says. "The stimulation does not eliminate the source of pain. It interferes with the signal, so the amount of pain relief varies for each person." The reversibility of SCS is one of its most important features. Unlike other surgical procedures that are commonly performed to relieve pain, SCS does not change a patient's spinal anatomy. Over the years, the application of SCS has continually evolved and improved. Peer-reviewed scientific journals have published a large body of clinical evidence demonstrating the positive benefits of SCS through randomized controlled trials, long-term case series of clinical outcomes, and cost-effectiveness studies. This evidence led to widespread acceptance of SCS which is now considered in the treatment of chronic back pain. "We have a number of weapons for relieving back and neck pain and we will use them to achieve our major objective – to find the pain source and treat it," Mallempati says.