Who May Benefit from Spinal Cord Stimulation

Nerve stimulation in the spinal cord is recommended for treating certain types of chronic pain, primarily when other treatments have not provided meaningful relief. 

Spinal cord stimulation is most successful in treating neuropathy or neuropathic pain – a type of constant, moderate-to-severe pain originating from nerve tissue dysfunction. Conditions that cause this type of pain are medically categorized as complex regional pain syndrome (CRPS) or refractory neuropathic pain.¹Garcia K, Wray JK, Kumar S. Spinal Cord Stimulation. [Updated 2023 Apr 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553154/

Spinal cord stimulation is also used in the management of ischemic pain, which refers to pain originating from blocked arteries. Ischemic pain is common in the heart and legs.²Dydyk AM, Tadi P. Spinal Cord Stimulator Implant. [Updated 2023 Jul 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555994/

Individuals who have pain relief after a sympathetic nerve block injection – an injection to numb pain-transmitting nerves – such as an epidural steroid injection or selective nerve block injection – are more likely to have better outcomes from spinal cord stimulation treatment.¹Garcia K, Wray JK, Kumar S. Spinal Cord Stimulation. [Updated 2023 Apr 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553154/

Common Conditions Treated with Spinal Cord Stimulation

Nerve stimulation is potentially effective for chronic pain conditions including but not limited to:

• Persistent spinal pain syndrome (PSPS) – one of the most common indications for spinal cord stimulation.³Traeger AC, Gilbert SE, Harris IA, Maher CG. Spinal cord stimulation for low back pain. Cochrane Database of Systematic Reviews 2023, Issue 3. Art. No.: CD014789. DOI:10.1002/14651858.CD014789.pub2
  • PSPS refers to chronic pain after back surgery fails to alleviate lower back pain and/or leg symptoms (such as sciatica and lumbar radiculopathy), or neck surgery does not relieve neck pain and/or arm symptoms (such as arm pain and cervical radiculopathy)³Traeger AC, Gilbert SE, Harris IA, Maher CG. Spinal cord stimulation for low back pain. Cochrane Database of Systematic Reviews 2023, Issue 3. Art. No.: CD014789. DOI:10.1002/14651858.CD014789.pub2
  • An older and more common term for persistent spinal pain syndrome in the lower back is failed back surgery syndrome (FBSS), which is now renamed as PSPS. 
• Chronic back pain – with or without leg pain³Traeger AC, Gilbert SE, Harris IA, Maher CG. Spinal cord stimulation for low back pain. Cochrane Database of Systematic Reviews 2023, Issue 3. Art. No.: CD014789. DOI:10.1002/14651858.CD014789.pub2
• Chronic neck pain – with or without arm pain⁴Amirdelfan K, Vallejo R, Benyamin R, et al. High-Frequency Spinal Cord Stimulation at 10 kHz for the Treatment of Combined Neck and Arm Pain: Results From a Prospective Multicenter Study. Neurosurgery. 2020;87(2):176-185. doi:10.1093/neuros/nyz495
• Peripheral neuropathy – nerve damage in the hands or feet causing weakness, numbness, and pain in the affected areas¹Garcia K, Wray JK, Kumar S. Spinal Cord Stimulation. [Updated 2023 Apr 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553154/
• Painful diabetic neuropathy – nerve damage due to diabetes resulting in severe pain and numbness in the hands, legs, and feet⁵Duarte RV, Nevitt S, Maden M, et al. Spinal cord stimulation for the management of painful diabetic neuropathy: a systematic review and meta-analysis of individual patient and aggregate data. Pain. 2021;162(11):2635-2643. doi:10.1097/j.pain.0000000000002262
• Complex regional pain syndrome (CRPS) – chronic pain in the arms and/or legs¹Garcia K, Wray JK, Kumar S. Spinal Cord Stimulation. [Updated 2023 Apr 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553154/
• Arachnoiditis – painful inflammation and scarring of the meninges (protective layers) of the spinal nerves⁶de la Porte C, Siegfried J. Lumbosacral spinal fibrosis (spinal arachnoiditis). Its diagnosis and treatment by spinal cord stimulation. Spine (Phila Pa 1976). 1983;8(6):593-603. Available from: https://pubmed.ncbi.nlm.nih.gov/6228017/

Nerve stimulation is also used off-label for the treatment of certain pain conditions. A few examples include:

• Peripheral ischemia – reduced blood flow to the leg(s) due to narrow, blocked, or clotted arteries (blood vessels)¹Garcia K, Wray JK, Kumar S. Spinal Cord Stimulation. [Updated 2023 Apr 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553154/
• Angina pectoris – discomfort and pain in the chest resulting from inadequate blood and/or oxygen reaching the heart, often due to a blood vessel issue¹Garcia K, Wray JK, Kumar S. Spinal Cord Stimulation. [Updated 2023 Apr 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553154/
• Refractory angina pectoris – reduced blood flow to the heart, which causes chest pain, shortness of breath, and fatigue⁷Pan X, Bao H, Si Y, et al. Spinal Cord Stimulation for Refractory Angina Pectoris: A Systematic Review and Meta-analysis. Clin J Pain. 2017;33(6):543-551. doi:10.1097/AJP.0000000000000435

Spinal cord stimulation is recommended for an increasing number of painful health problems, and this is not a comprehensive list of conditions the therapy may help.

Who Is a Good Candidate for Spinal Cord Stimulation

A good candidate for nerve stimulation is someone who:

• Has an underlying condition indicated for spinal cord stimulation treatment
• Has tried nonsurgical or surgical treatments without successful outcomes
  • Non-surgical treatments are typically tried for 1 year before considering spinal cord stimulation. However, in some cases, spinal cord stimulation may be considered a suitable treatment after six months of nonsurgical treatment.⁸Thomson S, Huygen F, Prangnell S, et al. Appropriate referral and selection of patients with chronic pain for spinal cord stimulation: European consensus recommendations and e-health tool. Eur J Pain. 2020;24(6):1169-1181. doi:10.1002/ejp.1562^,9Kriek, N., Groeneweg, J., Stronks, D. et al. Comparison of tonic spinal cord stimulation, high-frequency and burst stimulation in patients with complex regional pain syndrome: a double-blind, randomised placebo controlled trial. BMC Musculoskelet Disord 16, 222 (2015). https://doi.org/10.1186/s12891-015-0650-y
• Has had a successful spinal cord stimulator trial with the following results:
  • There is at least a 50% reduction in pain¹⁰Sitzman BT, Provenzano DA. Best practices in spinal cord stimulation. Spine. 2017;42(14):S67-S71. doi:10.1097/BRS.0000000000002220
  • There are improvements in function, such as¹⁰Sitzman BT, Provenzano DA. Best practices in spinal cord stimulation. Spine. 2017;42(14):S67-S71. doi:10.1097/BRS.0000000000002220:
    • Better tolerance while walking
    • Improved sleep quality
    • Increased ease in performing daily activities and chores
    • Enhanced overall quality of life
• Is willing and able to actively engage in managing their pain and taking ownership of ongoing responsibilities, such as regular follow-ups, device programming, device care, and scheduled wireless recharging (for implantable devices).¹Garcia K, Wray JK, Kumar S. Spinal Cord Stimulation. [Updated 2023 Apr 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553154/

If these criteria are met, the doctor and patient together discuss the possibility of a permanent stimulator implant. 

When Spinal Cord Stimulation Is Not Advised

If a patient has an unsuccessful spinal cord stimulation trial, a permanent stimulator implant is not advisable.

Other general contraindications for nerve stimulation include but are not limited to¹Garcia K, Wray JK, Kumar S. Spinal Cord Stimulation. [Updated 2023 Apr 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553154/:

• Areas of pain not able to be pinpointed or mapped to a specific area (broad areas of chronic pain)
• A systemic infection (an infection in the bloodstream that affects the entire body)
• An infection at the site where the device would be implanted
• An unusual or rare anatomic variation at the surgical site that would interfere with the safe implantation of the leads or device
• Uncontrolled or untreated systemic illness (such as high blood pressure or diabetes)
• Uncontrolled or untreated bleeding disorder

Additional factors may also influence the recommendation and timing of spinal cord stimulation. For example, if a patient has a psychological condition such as depression, a psychological evaluation is recommended¹; nicotine use is linked to low success with this procedure, so patients are counseled to stop smoking, vaping, or using other forms of nicotine before initiating the treatment.¹¹De La Cruz P, Fama C, Roth S, et al. Predictors of Spinal Cord Stimulation Success. Neuromodulation. 2015;18(7):599-602. doi:10.1111/ner.12325