Is Spinal Cord Stimulation Right for My Pain?

Yes, spinal cord stimulation may be right for you if persistent nerve pain has not improved after at least six months of conservative treatment. It uses mild electrical impulses to modify pain signals before they reach your brain. However, your doctor will evaluate your diagnosis, pain pattern, and previous treatment response before recommending this treatment.

At Total Orthopedics & Sports Medicine, our physical medicine specialist, Dr. J. Everett Kooch, helps you evaluate spinal cord stimulation without committing to a permanent device. He uses the temporary trial to measure changes in your symptoms and function. If the improvement does not meet your treatment goals, he will explore other treatment options before proceeding with a permanent spinal cord stimulator. Call 855-321-6784 to book your appointment.

When Do Doctors Recommend Spinal Cord Stimulation?

Our pain management specialist, Dr. J. Everett Kooch, may recommend spinal cord stimulation when persistent pain significantly limits your ability to walk, work, sleep, or manage everyday activities. He carefully reviews the underlying pain mechanism and the effectiveness of previous treatments. These findings help him identify whether spinal cord stimulation can address the nerve pathways contributing to your ongoing pain.

In addition to evaluating your pain pattern, Dr. J. Everett Kooch analyzes whether your symptoms result from a structural condition that requires direct treatment. For example, significant nerve compression or spinal instability may require a different intervention before stimulation is considered. This distinction helps guide treatment toward the underlying problem rather than the severity of pain alone.

A 2023 evidence-based consensus guideline published in Regional Anesthesia and Pain Medicine recommends a comprehensive evaluation before spinal cord stimulation. Doctors should assess the underlying pain condition, response to previous treatments, psychosocial factors, and other clinical characteristics that may affect treatment outcomes. The guideline also recommends a temporary SCS trial before permanent implantation to evaluate the patient’s response to stimulation.

Which Pain Conditions Can a Spinal Stimulator Treat?

A spinal cord stimulator may help manage failed back surgery syndrome, complex regional pain syndrome, and painful diabetic neuropathy. Doctors may also recommend it for selected patients with persistent neuropathic low back pain or radiating leg pain. However, SCS generally targets nerve-related pain rather than isolated muscle pain, so identifying the source of your symptoms is essential before treatment.

Depending on the underlying pain mechanism, doctors may also recommend spinal cord stimulation for the following conditions:

• Chronic Lumbar Radiculopathy: Persistent nerve-root pain that radiates from the lower back into the leg.
• Chronic Cervical Radiculopathy: Ongoing nerve-related pain that extends from the neck into the shoulder, arm, or hand.
• Spinal Stenosis-Related Pain: Persistent symptoms associated with narrowing around the spinal nerves in carefully selected patients.
• Arachnoiditis: Chronic inflammation and scarring around spinal nerves that can cause persistent neuropathic symptoms.
• Degenerative Spine-Related Neuropathic Pain: Chronic nerve-related symptoms associated with degenerative changes when other appropriate treatments have not provided long-term pain relief.

Note: Spinal cord stimulation may help manage persistent neuropathic pain associated with these conditions, but it does not correct structural problems. Therefore, your doctor first determines whether the underlying structural problem requires direct treatment.

What Treatments Should You Try Before a Pain Stimulator?

Before considering a pain stimulator, you should generally try pain medications, structured rehabilitation, targeted spinal injections, or nerve blocks. Your doctor chooses the right treatment based on the source of your pain and how it affects your function. If these options do not manage pain, your doctor may recommend spinal cord stimulation for longer-term symptom control.

However, you do not need to try every available pain treatment before spinal cord stimulation is considered. Your doctor focuses on treatments that match your diagnosis and the source of your symptoms. For example, you may not need repeated injections if your pain results from ongoing nerve damage rather than inflammation.

How Do Doctors Decide If You Need SCS?

Dr. J. Everett Kooch determines your eligibility for SCS through a detailed neurological examination and diagnostic testing. During the neurological examination, our doctor evaluates your strength, sensation, reflexes, and other signs of nerve dysfunction. He then compares these findings with your imaging results to determine whether the identified spinal changes correspond with your symptoms. This helps distinguish pain that may respond to SCS from conditions that require a different treatment approach.

At our clinic, patients often tell us they have spent months trying different treatments but still do not understand why their pain continues. Without knowing exactly what is causing the symptoms, it can be difficult to choose the right treatment. In such cases, an accurate diagnosis can help you avoid going through another treatment without knowing whether it addresses your pain. If you have already tried several treatments without finding the answers you need, schedule an evaluation to confirm your diagnosis and determine your SCS candidacy.

Does Pain Duration Affect SCS Candidacy?

Yes, the duration of pain can affect your candidacy for spinal cord stimulation, as SCS is generally considered for treating chronic pain rather than short-term symptoms. Doctors first confirm that conservative treatments have not provided adequate or lasting improvement. If severe pain persists despite these treatments, doctors may recommend SCS as part of a long-term pain management strategy.

Research also confirms that the duration of time you have experienced pain may affect treatment outcomes. A systematic review of 74 studies involving 3,025 patients found that studies with longer average pain duration generally reported less pain relief after spinal cord stimulation. However, pain duration alone does not determine treatment success, so doctors assess it alongside other clinical factors when evaluating your candidacy.

Who Should Not Get a Pain Stimulator?

Patients with an active infection, uncontrolled bleeding disorder, or certain medical conditions may not be suitable candidates for a pain stimulator. Beyond these medical concerns, doctors may not recommend SCS if your symptoms are not consistent with nerve-related pain or if another condition requires treatment first. In these situations, the doctor may treat the underlying problem first or recommend a different approach to managing your pain.

Here are some other conditions in which doctors may not recommend SCS:

• Uncontrolled Mental Health Conditions: Severe, untreated depression, anxiety, psychosis, or other psychiatric conditions may affect treatment outcomes.
• Active Substance Use Disorder: Uncontrolled substance misuse may need to be addressed before proceeding with SCS.
• Inability to Operate the Device: You need to understand how to use and manage the stimulator after implantation.
• Unable to Complete the SCS Trial: A successful trial period is generally required before doctors proceed with a permanent implantation procedure.
• Limited Benefit During the Trial: If the temporary stimulator does not provide meaningful pain relief or functional improvement, permanent implantation may not be recommended.
• Difficulty Following the Recovery Plan: Difficulty following wound care, activity restrictions, or follow-up requirements may increase the risk of complications.
• Pregnancy: Doctors generally avoid elective SCS implantation during pregnancy and may postpone treatment until delivery.
• Device or Anatomical Limitations: Previous spine procedures, anatomical changes in the spine, or existing medical devices may make SCS placement more difficult.

A 2023 evidence-based consensus guideline also recommends psychosocial screening before SCS. It identifies active psychosis and ongoing substance use disorder as important reasons to delay treatment until these conditions are appropriately managed. Similarly, the Neurostimulation Appropriateness Consensus Committee (NACC) recommends identifying and managing infection risks before neurostimulation procedures. Because SCS involves implanted leads and hardware, an active infection may require treatment before implantation to reduce the risk of infection.

How Is a Spinal Stimulator Trial Performed?

During a spinal cord stimulator trial, your doctor places temporary leads into the epidural space near your spinal cord and connects them to an external generator. The system then sends mild electrical impulses to the targeted nerves. Over the next several days, you track your pain relief and daily function to assess how well the stimulation works.

Here is the step-by-step process your doctor follows during a spinal cord stimulator trial:

1. Treatment Area Preparation

Your doctor first positions you comfortably to allow clear access to the treatment area. Then, the skin over your spine is carefully cleaned and numbed with a local anesthetic. Once the anesthetic takes effect, the doctor makes a small incision in the lower back.

2. Temporary Lead Placement

After preparing the treatment area, your doctor guides thin wires into the epidural space near your spinal cord using imaging guidance. They position the leads at the spinal level corresponding to your pain. Once properly positioned, the leads can deliver stimulation to the targeted nerve pathways.

3. External Generator Connection

The temporary leads connect to a small external generator that provides the electrical stimulation during the trial. This small device sends electrical impulses through the leads to the targeted nerves. Then the doctor adjusts the settings based on the location of your pain and your response to stimulation.

4. Stimulation Testing

Once the system is activated, your doctor checks how the stimulation affects the areas where you normally feel pain. The settings can be adjusted to improve coverage and comfort. Moreover, these adjustments set the stimulation levels you will use during the trial to evaluate changes in your pain and daily function.

5. Trial Period

The trial typically lasts several days, allowing you to evaluate how the stimulation affects your pain during normal daily activities. Throughout this period, you monitor changes in your pain and physical function. These changes help show whether SCS provides enough improvement to proceed with permanent implantation.

6. Temporary Lead Removal

When the trial period is complete, your doctor removes the temporary leads and evaluates your response to SCS. They review changes in your pain levels and your ability to perform daily activities. These results help determine whether you may benefit from a permanent spinal cord stimulator.

How Long Does a SCS Procedure Take?

An SCS procedure usually takes about one to two hours, although the exact time depends on the type of procedure and lead placement. A temporary trial may take less time than permanent implantation. After the procedure, your care team monitors you briefly for pain, bleeding, or any immediate complications. Additionally, you can usually return home the same day, with a follow-up appointment scheduled within one to two weeks to review your progress.

What Makes a Stimulator Trial Successful?

A stimulator trial is considered successful when it provides at least 50% pain relief or improvement in your daily function. Our pain management doctor compares these results with the goals set before the trial. Improvements in walking, sleep, activity tolerance, and pain medication use may also support the decision to proceed with a permanent implant.

In fact, consensus guidelines recommend evaluating SCS trial success using multiple clinical outcomes rather than pain scores alone. Although a 50% or greater reduction in pain is generally considered a successful trial, improvements in function, medication use, patient satisfaction, and treatment tolerability may also help guide the decision to proceed with permanent implantation.

How Do Doctors Proceed After the Trial?

After the SCS trial, your doctor removes the temporary leads before planning permanent implantation as a separate procedure. They use the information gathered during the trial to plan the permanent leads and stimulation settings. Before implantation, you may also receive instructions regarding medications, activity, and preparation for the procedure.

However, a successful trial does not mean you have to permanently implant the system right away. Before the procedure, your doctor explains what you can expect from long-term stimulation based on how you responded during the trial. You can then review these expected benefits, along with the risks and follow-up care, before making a final decision.

How Effective Is a Pain Stimulator for Chronic Pain?

The average spinal cord stimulator success rate is 50% or higher in carefully selected patients with chronic back or leg pain, according to a study published in PubMed. Similarly, in a 24-month randomized controlled trial, patients receiving 10-kHz SCS experienced an average 66.9% reduction in back pain and 65.1% reduction in leg pain at two years.

Another 24-month study of patients with nonsurgical refractory back pain reported a 73% average reduction in back pain, with 82% of patients achieving at least 50% pain relief. Moreover, a prospective multicenter study found that average back pain scores decreased from 8.4 to 3.3 out of 10 after two years of high-frequency SCS treatment. Patients also experienced significant improvements in disability, sleep disturbances, and opioid use. However, how effectively spinal cord stimulation works in your case depends on your pain source, previous treatments, and response during the trial period.

Can SCS Reduce the Need for Pain Medication?

Yes, SCS can reduce the need for pain medication in some patients with chronic pain. As your pain improves, you may gradually reduce your reliance on certain pain medications. But your doctor adjusts your medications based on your treatment response, pain level, and overall function rather than stopping them immediately after treatment.

Here’s how SCS may help reduce your reliance on pain medication:

• Changes Pain Signal Processing: SCS modifies how pain signals travel through the nervous system before they reach the brain.
• Provides Ongoing Pain Control: Continuous stimulation may help control symptoms throughout the day without relying only on medication.
• Improves Activity Tolerance: Better pain control may help you move and complete daily activities with less discomfort.
• Reduces Pain Flare-Ups: More consistent pain control may reduce sudden symptom flare-ups that increase the need for additional medication.

What Are the Possible Risks of a Pain Stimulator?

The possible risks of a pain stimulator include infection, bleeding, nerve injury, lead movement, and a dural puncture. You may also experience temporary soreness or a tingling sensation near the treatment area. However, following proper safety protocols and your doctor’s recovery instructions can help reduce these risks.

Additionally, you may experience the following complications after spinal cord stimulation:

• Lead Breakage: Damaged leads may reduce stimulation and require replacement.
• Device Malfunction: Battery or connection problems may interrupt treatment.
• Unwanted Stimulation: You may feel uncomfortable stimulation in unexpected areas.
• Loss of Pain Relief: SCS may become less effective over time.
• Implant Site Pain: Discomfort may persist around the implanted device.
• Fluid Buildup: Fluid may collect around the surgical area.
• Scar Tissue Formation: Scar tissue may occasionally affect stimulation or cause discomfort.
• Revision Spinal Cord Stimulator Surgery: Device problems may require repositioning, replacement, or removal.

To reduce these risks, our Interventional Spine Specialist, Dr. J. Everett Kooch, carefully evaluates your condition before recommending spinal cord stimulation. He uses precise diagnosis and targeted interventional techniques to plan treatment while following appropriate safety measures. If a complication develops, he promptly evaluates the problem and adjusts your treatment accordingly. Depending on the issue, he may recommend device reprogramming, additional monitoring, or further intervention when necessary. Book an appointment with Dr. J. Everett Kooch to understand the benefits and potential risks of spinal cord stimulation before moving forward.

How Soon Can You Recover After Device Placement?

You can usually recover from spinal cord stimulator placement within 2 to 6 weeks, although the exact timeline depends on your healing and activity level. You may resume light activities earlier, but bending, lifting, and strenuous exercise are restricted initially. Your doctor gradually increases activity as the incision heals and your recovery progresses.

Johns Hopkins Medicine also reports that incisions often heal within two to four weeks, while light activity may begin during the first one to two weeks and gradually increase as recovery progresses. Furthermore, a PubMed study evaluating 102 patients with spinal cord stimulators reported that available postoperative recommendations suggested an average return-to-work time of approximately 6.1 weeks after implantation.

Are There Any Long-Term Restrictions After Treatment?

Yes, you may have some long-term restrictions after spinal cord stimulation. But most people gradually return to everyday life after recovery. Depending on your device, you may need specific precautions for MRI scans, metal detectors, and certain medical procedures. If your system is MRI compatible, you still need to follow the specific scanning conditions provided by the device manufacturer.

In addition, your doctor may recommend the following precautions to protect the implanted system over time:

• Avoid High-Impact Trauma: Contact sports or activities involving repeated falls may damage or shift implanted components.
• Inform Healthcare Providers: Tell doctors and dentists about your stimulator before undergoing procedures or treatments.
• Use the Device as Directed: Follow instructions for adjusting stimulation and using your remote control.
• Follow Charging Instructions: If you have a rechargeable system, maintain the power source according to the recommended charging schedule.
• Avoid Certain Electrical Procedures: Some procedures that generate strong electrical or electromagnetic energy may interfere with the device.
• Carry Device Identification: Keep your implant identification card available when traveling and inform security personnel about your implanted device when necessary.
• Attend Regular Follow-Ups: Routine checks help confirm that the device continues to function properly and address changes in pain control.

How Long Does a Spinal Cord Stimulator Last?

A spinal cord stimulator can typically last 5 to 10 years or longer, depending on the type of pulse generator and how often you use it. Besides that, rechargeable systems may last longer than non-rechargeable devices. Once the battery reaches the end of its lifespan, doctors usually replace the generator without replacing the entire system.

A large real-world study of 106,462 spinal cord stimulators projected a median device lifespan of 8.2 years for non-rechargeable systems and 9.0 years for rechargeable systems. Another long-term comparative study found that rechargeable pulse generators had a median battery longevity of 7.2 years, compared with 3.7 years for non-rechargeable devices.

Can a Pain Stimulator Be Removed If Needed?

Yes, your doctor can remove a pain stimulator if it stops providing pain relief or causes ongoing complications. Unlike many permanent procedures, the implanted system can be surgically removed when necessary. Before proceeding with removal, your doctor evaluates the problem and recommends the most suitable approach based on the device and your symptoms.

In some situations, your doctor may reposition or replace part of the device instead of removing the entire system. For example, if a lead has shifted but the system still provides effective pain relief, your doctor may reposition the lead rather than remove the entire device. In contrast, if the battery, pulse generator, or another component stops working properly, they may replace only the affected part. However, complete removal may be necessary for infection, persistent implant-site pain, repeated device problems, or loss of long-term relief.

Consult Dr. J. Everett Kooch to Find the Right SCS Approach for Your Condition!

Your pain may not feel the same throughout the day. It may increase when you stand, travel down your leg while walking, or become more severe when you sit or sleep. Since different pain pathways can contribute to your symptoms, the right SCS approach may vary from one patient to another.

At Total Orthopedics & Sports Medicine, Dr. J. Everett Kooch evaluates these individual pain patterns before guiding your SCS treatment. He carefully assesses your pain location, symptom pattern, activity triggers, and response during the SCS trial. Then, he uses these findings to recommend an approach that aligns with your condition and treatment goals. For personalized SCS evaluation and continued care throughout your treatment, call 855-321-6784 or visit our clinic.

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