Spinal cord stimulation treats chronic neuropathic pain by delivering electrical pulses to the spinal cord through electrodes placed in the epidural space. Its distinguishing feature is that it is tested before it is committed to: a trial period with temporary electrodes shows whether the patient's own pain responds, and only patients who respond during the trial proceed to a permanent implant.
At a glance
- Main indications
- Neuropathic pain, failed back surgery syndrome, complex regional pain syndrome, radiculopathy after surgery, phantom limb pain, selected ischaemic pain
- Trial period
- Temporary electrodes for several days to about two weeks before permanent implantation
- Threshold to proceed
- Usually at least 50% pain reduction during the trial, with improved function
- Implant
- Epidural electrodes (percutaneous or surgical paddle) and a pulse generator in the flank or buttock
- Less effective for
- Purely nociceptive or mechanical pain, and widespread non-specific pain
- Reversible
- Yes
The trial is the point
Very few treatments in medicine allow the patient to test them before deciding. Spinal cord stimulation does. Temporary electrodes are placed, connected to an external generator, and the patient lives normally with them for days to about two weeks — sleeping, walking, doing ordinary things — and records what happens to their pain and their function.
If the trial does not produce meaningful benefit, the electrodes are removed and nothing further is implanted. This filters out the patients for whom the treatment would not have worked, which is why properly conducted trials matter more than any preoperative prediction.
Who tends to benefit
- Pain that is clearly neuropathic in character — burning, electrical, shooting, with numbness or altered sensation in a recognisable nerve distribution.
- Persistent leg or arm pain after spine surgery, where further surgery is not indicated.
- Complex regional pain syndrome.
- Phantom limb and stump pain after amputation.
- Selected ischaemic limb pain, including in Buerger's disease, where revascularisation is not possible — stimulation may relieve pain and, in some reports, assist wound healing.
Yılmaz A, Yıldızgören MT, Melek İ, Doğan ÖV. Spinal Cord Stimulation may improve not only intractable pain but also necrotic wounds. Turkish Journal of Physical Medicine and Rehabilitation, 2018.
Percutaneous leads or a surgical paddle?
Percutaneous leads are placed through a needle under local anaesthesia and X-ray guidance, and are usually used for the trial. Surgical paddle electrodes require a small laminotomy but sit more stably, cover a broader area and are less prone to migration; they are often preferred for permanent implantation in particular patterns of pain, or when percutaneous leads have not held position.
Realistic expectations
The goal is not to abolish pain. It is to reduce it enough — commonly by half or more in patients who respond to the trial — that sleep, mobility, activity and medication requirements improve. Patients told to expect a pain-free life are being misled; patients told to expect a manageable life are usually satisfied. Benefit can also fade over years, and reprogramming or, occasionally, revision may be needed.
Ask about spinal cord stimulation
Frequently asked questions
Does spinal cord stimulation cure pain?
No. It reduces pain, typically by half or more in patients who respond during the trial, with the aim of improving sleep, function and medication requirements. It does not treat the underlying cause.
What happens if the trial does not help?
The temporary electrodes are removed and no permanent system is implanted. This is a normal and expected outcome for a proportion of patients, and is precisely why the trial exists.