Practice Parameters for the Use of Spinal Cord Stimulation in the Treatment of Chronic Neuropathic Pain

Choosing a Pulse Generator

What factors dictate the choice of stimulator/power generator?

  • The patient's ability to control the device, which can be limited by age (too young) or age-related infirmity (too old).
  • During implantation in children who have yet to reach their full stature, provisions for growth should be considered.
  • The amount of power required, which influences battery depletion and might be a factor even for rechargeable batteries, which must eventually be replaced.
  • Patient convenience
  • Patient cosmetic concerns

Generators have multiple outputs connected to individual electrode contacts.  Most deliver single-channel (as opposed to multi-channel) stimulation; that is, they cannot simultaneously deliver different voltage or current levels to different electrode contacts, although they might do so sequentially.

Strength of recommendation Evidence source(s)/rationale
N/A -- information only N/A -- see Bibliography for relevant literature

Stultz M. Quality of life, function and pain relief attributed to two types of spinal cord stimulation systems: result of a patient survey. Pain Digest 9:348-352, 1999.
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Oakley J, Krames E, Weiner R, Grandhe V, Moffitt M, Bradley K. Bilateral current fractionalization in spinal cord stimulation [abstract]. Neuromodulation 9(1):17-18, 2006.

North RB, Kidd DH, Zahurak M, James CS, Long DM. Spinal cord stimulation for chronic, intractable pain: experience over two decades. Neurosurgery 32(3):384-394, 1993.
Abstract | Wikistim Entry

North RB, Ewend ME, Lawton MA, Piantadosi S. Spinal cord stimulation for chronic, intractable pain: superiority of "multi-channel" devices. Pain 44(2):119-130, 1991.
Abstract | Wikistim Entry

Devulder J, De Laat M, Rolly G. Dual channel electrostimulation in pain. Acta Neurol Belg 98(2):195-198, 1998.

Deer T, Kim C, Bowman R, Norris M, Stewart D, Garten T, Kahn Y. Initial experience with a new rechargeable generator: a report of twenty systems at 3 months status postimplant in patients with lumbar postlaminectomy syndrome [abstract]. Neuromodulation 9(1):9-10, 2006.
| Wikistim Entry