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

Summary

Spinal cord stimulation (SCS) is a reversible pain therapy applied with sophisticated techniques that include multi-output implanted pulse generators  and a choice of electrodes, some of which can be placed percutaneously.  Patients must pass an SCS screening trial before undergoing implantation of a permanent system.  The technical goal of the screening trial is to achieve stimulation paresthesia at a subjectively comfortable level, overlapping a patient's topography of pain.  Technical success, however, is not sufficient to ensure clinical success.  Some patients with complete coverage of the topography of pain report little or no pain relief.

These practice parameters provide a synthesized, critical, and clear compilation of the information needed to optimize the use of SCS as a treatment of chronic neuropathic pain.  The target audience is:

• Health care providers adopting best practices for referral and treatment
• Medical school faculty improving education and training
• Scientists identifying research targets
• Policy-makers
• Device manufacturers identifying research and development targets
• Insurers quantifying and improving cost effectiveness
• Patients making informed decisions
• The general public

Although the information in this document might influence or reinforce physician choices, it is not intended to be coercive or judgmental.  The evidence that supports the clinical decisions and treatment options is presented and graded with the sole objective of increasing the confidence of clinicians who wish to incorporate this information into their practices.  In addition, the information provided has important implications for the cost and consumption of health care resources, which will be appropriately noted.

These practice parameters will apply to the majority of patients; in each case, however, the answers (summarized below) to the clinical practice questions are useful for individualizing treatment and are not meant to substitute for a clinician's best judgment.