Chronic refractory pain
Pain remains meaningful despite an appropriate course of conservative, medication, rehabilitative, or interventional treatment.
SPINAL CORD STIMULATION
Advanced neuromodulation for selected chronic pain conditions.
Spinal cord stimulation (SCS) uses targeted electrical stimulation to influence pain signaling. For appropriately selected patients with chronic, difficult-to-treat pain, SCS may be considered when more conservative treatment has not provided adequate improvement.
NEUROMODULATION
Changing how pain signals are processed.
Spinal cord stimulation delivers mild electrical impulses through thin leads placed in the epidural space. These signals modify pain transmission before it is perceived by the brain.
Modern SCS systems use different stimulation patterns and programming strategies. The appropriate system and settings depend on the pain condition, treatment goals, anatomy, prior care, and individual response to therapy.
PATIENT SELECTION
Who may be a candidate?
SCS is not a first-line treatment for most pain conditions. A careful evaluation is used to determine whether neuromodulation fits the diagnosis, prior treatment, and the patient’s goals.
Appropriate pain pattern
The diagnosis and pain distribution are consistent with a condition for which spinal cord stimulation may reasonably be considered.
Thoughtful screening
Medical, functional, and psychosocial factors are reviewed along with the patient’s understanding of the therapy and expectations for treatment.
Clear functional goals
The treatment plan focuses on meaningful improvement in pain, function, activity tolerance, and quality of life rather than any single measure alone.
THE SCS TRIAL
Try the therapy before deciding on an implant.
For most chronic pain indications, SCS begins with a temporary trial. Thin leads are placed in the epidural space and connected to an external stimulator, allowing the patient to experience the therapy over several days.
The trial is used to evaluate meaningful clinical benefit, including changes in pain and function, before deciding whether to proceed with a permanent implanted system. A successful trial does not obligate a patient to move forward with implantation.
SELECTION & EXPECTATIONS
The trial is part of the decision—not the entire decision.
Evidence-based consensus recommendations emphasize appropriate indication, psychosocial screening, patient education, realistic expectations, and a screening trial before definitive implantation for most chronic pain indications. Trial response should be assessed across pain relief, function, medication use, satisfaction, and patient-specific goals.
Diagnosis firstSCS should match an appropriate chronic pain indication and clinical picture.
Trial before implantThe temporary trial provides an opportunity to assess the therapy before permanent implantation.
Function mattersSuccess is evaluated beyond pain scores alone, including meaningful functional goals.
WHAT TO EXPECT
A stepwise approach to neuromodulation.
Evaluation & screening
The process includes review of the diagnosis, prior treatment, imaging when relevant, functional goals, medical considerations, and psychosocial factors that may influence long-term outcomes.
Temporary trial
Trial leads are placed using image guidance and connected to an external stimulator. The therapy is evaluated during normal daily activity over the trial period.
Permanent system
If the trial provides meaningful benefit and SCS remains appropriate, permanent implantation may be considered. Long-term care includes programming, follow-up, and management of the implanted system.
FREQUENTLY ASKED QUESTIONS
Common questions about spinal cord stimulation.
What conditions can spinal cord stimulation treat?
SCS may be considered for selected chronic pain conditions, including certain neuropathic pain syndromes and persistent back or leg pain. Indications vary by device and clinical situation, so candidacy is determined through an individualized evaluation.
Is the trial the same as the permanent implant?
No. The trial provides temporary stimulation so that the patient and physician can evaluate the therapy before deciding whether permanent implantation is appropriate.
What makes an SCS trial successful?
Pain relief is important, but trial response is evaluated more broadly. Functional improvement, patient-specific activity goals, medication use when relevant, tolerability, and overall satisfaction with the therapy may also be considered.
Will I feel the stimulation?
That depends on the SCS system and programming. Some stimulation approaches produce a tingling sensation called paresthesia, while others are designed to provide therapy without a noticeable stimulation sensation.
Does a successful trial mean I have to get an implant?
No. A successful trial provides additional information for shared decision-making but does not require a patient to proceed with implantation. The decision also considers the degree of benefit, treatment goals, patient preferences, and the overall clinical picture.
NEXT STEP
Could neuromodulation be part of your treatment plan?
A focused evaluation can help determine whether spinal cord stimulation may be appropriate to consider and whether an SCS trial is a reasonable next step.
Request an AppointmentThis page provides general educational information and does not replace an individualized medical evaluation. Spinal cord stimulation systems have device-specific indications, contraindications, risks, and instructions for use. Treatment recommendations, alternatives, and expectations should be reviewed as part of an individualized treatment discussion.