What to Expect When Testing and Placing a Spinal Cord Stimulator
Spinal cord stimulation (SCS) uses a small implanted device to send mild electrical signals to the spinal cord, changing how pain signals are processed before they reach the brain. Depending on the device, you may feel a gentle tingling or nothing at all. A key advantage of SCS is that you test it first. A temporary trial lasting about a week lets you see how much it helps in daily life before deciding on a permanent implant.
Who May Be a Candidate
Chronic back and leg pain after spine surgery (persistent spinal pain syndrome, previously called failed back surgery syndrome).
Chronic back or leg pain in people who aren't surgical candidates.
Complex regional pain syndrome (CRPS).
Painful diabetic neuropathy of the feet.
Other chronic nerve pain that hasn't improved with medications, therapy, and injections.
A psychological evaluation is a standard part of preparing for SCS. It helps make sure you have the tools and support to get the most from the therapy.
Step 1: The Trial
In an outpatient procedure, one or two thin, flexible wires (leads) are placed through a needle into the epidural space under x-ray guidance.
The leads connect to a small external battery you wear on a belt.
A representative from the device company programs the stimulator with you.
For about 5 to 10 days, you go about your normal routine and track pain, activity, sleep, and medication use.
The leads are then removed in the office, which takes only a few minutes.
A trial is usually considered successful if your pain improves by at least 50% and your function improves.
Step 2: The Permanent Implant
After a successful trial, new leads are placed and connected to a small battery (generator) implanted under the skin, usually in the buttock or flank.
The procedure is done as an outpatient or with a short stay.
Incisions heal over about two weeks.
Many current devices are rechargeable and MRI-conditional, meaning certain MRI scans can still be done.
Before Your Procedure
Blood thinners: Any hold is coordinated with your prescribing doctor. Never stop a blood thinner on your own.
Infection prevention: You may be asked to wash with a special antiseptic soap. Tell us about any skin infection or open sore.
Diabetes: Good blood sugar control lowers the risk of infection.
Transportation: You will need a driver.
After Your Procedure
For the first 6 to 8 weeks after the implant, avoid bending, lifting more than about 5 to 10 pounds, twisting, or reaching overhead so the leads can settle in place.
Keep the incisions clean and dry, and follow your wound care instructions.
Programming adjustments are made at follow-up visits.
Physical therapy and gradual activity help you build on the pain relief.
Risks and Safety
Common: Incision soreness and a learning period to find the best settings.
Uncommon: Lead movement, which may require reprogramming or a revision procedure.
Rare: Infection, bleeding, spinal fluid leak with headache, or device malfunction.
Very rare: Nerve or spinal cord injury.
How Strong Is the Evidence?
Persistent pain after back surgery: Level I · Neurostimulation Appropriateness Consensus Committee (NACC) guidelines; randomized trials
Chronic back and leg pain (10 kHz therapy): Level I · SENZA-RCT (Kapural et al., Anesthesiology 2015)
Painful diabetic neuropathy: Level I · SENZA-PDN randomized trial (Petersen et al., JAMA Neurol 2021)
CRPS (dorsal root ganglion stimulation): Level I · ACCURATE randomized trial (Deer et al., Pain 2017)
Evidence levels and guideline citations above are summarized for general clinical reference based on the literature and major society guidelines available at the time of writing. Guidelines are periodically updated; please verify current recommendations before relying on this summary for clinical decision-making.
Alternatives
Alternatives include continued medications and therapy, injections and radiofrequency ablation, peripheral nerve stimulation, and surgical evaluation. We review the benefits and trade-offs of each with you.
Conditions This May Help
Talk With Us About Your Options
Call 650-507-4113 or send us a message to schedule a consultation at our Daly City, Los Altos, or Stockton office. We will review what may be causing your pain and walk through the risks, benefits, and alternatives of each option with you.
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This information is provided for general patient education and does not replace individualized medical advice. Please discuss your specific symptoms, diagnosis, and treatment options with your pain management physician.
