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

Summary Patient Management

To reduce the general risk of SCS, discharge instructions must indicate when and how to contact the patient’s physicians, the device manufacturer, and emergency care providers.

Follow-up:

Follow-up visits should occur as often as necessary to ensure safe and effective operation of the stimulator.  The patient should have a postoperative surgical check and SCS adjustment, and on postoperative day 7 to 14, the patient should return for suture or staple removal and any needed additional adjustment.  From that point forward, monthly visits should gradually taper to yearly visits.

Elective follow-up of a new patient who was implanted elsewhere should adhere to the routine that applies to any new patient.  As is standard, a physician has the discretion to accept or reject any new patient.  In emergencies, however, the patient might require immediate treatment.

To receive appropriate emergency treatment, SCS patients are provided with identification cards from the device manufacturer that contain information on how to contact their physician and the manufacturer’s representative.

Pain management:

• Baclofen and gabapentin can potentiate the therapeutic impact of SCS.
• All other pain treatments remain available.
• Adjunct treatment is beneficial if a patient’s pain has a nociceptive component, which SCS is not expected to treat.
• On/off time has a direct effect on battery longevity, but the impact of an imposed duty cycle on pain relief is unknown.  In some patients, pain relief persists for a week after the device is turned off; others must operate the stimulator continuously to obtain pain relief.

SCS patient precautions:

• Avoid placing excessive strain on the system.
• Avoid bending, twisting, or lifting weights over eight pounds (one gallon) for the first 6 weeks after implantation.
• No scuba diving more than 10 meters deep.
• No entry into hyperbaric chambers with the absolute pressure above 2.0 atmospheres.
• Disable the SCS system before entering electromagnetic fields produced by anti-theft devices or security screening systems.

Medical procedures requiring special precautions:

• Routine medical tests that might interact with, or be influenced by, the stimulator (e.g., cardiac monitoring)
• Radiation therapy that might capture the pulse generator in the active field
• Radiofrequency ablation or electrocautery
• Lithotripsy

Medical procedures contraindicated after implantation of an SCS system:

• MRI
• Ultrasound over the device 
• Diathermy in all body locations