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

Adjunct Pain Treatment

What adjunct pain treatment is available?

Baclofen and gabapentin can potentiate the pain relief achieved with SCS.

Because we have no indication of cross-tolerance between SCS and other pain treatments, all pain treatments remain available.  The use of adjunct treatment is beneficial if a patient’s pain has a nociceptive component, which SCS is not expected to treat.

Strength of recommendation Evidence source(s)/rationale
A = Recommended or required
Valid, useful, or non-negotiable
  • Weighing risk versus potential benefit and expert consensus reveals a high likelihood of a favorable outcome

Wallin J, Cui JG, Yakhnitsa V, Schechtmann G, Meyerson BA, Linderoth B. Gabapentin and pregabalin suppress tactile allodynia and potentiate spinal cord stimulation in a model of neuropathy. Eur J Pain 6(4):261-272, 2002.
Abstract

van Buyten J-P, van Zundert J, Vueghs P, Vanduffel L. Efficacy of spinal cord stimulation: 10 years of experience in a pain centre in Belgium. Eur J Pain 5(3):299-307, 2001.
Abstract | Wikistim Entry

Lind G, Schechtmann G, Winter J, Meyerson BA, Linderoth B. Baclofen-enhanced spinal cord stimulation and intrathecal baclofen alone for neuropathic pain: long-term outcome of a pilot study. Eur J Pain 12(1):132-136, 2008.
Abstract | Wikistim Entry

Lind G, Meyerson BA, Winter J, Linderoth B. Intrathecal baclofen as an adjuvant therapy to enhance the effect of spinal cord stimulation in neuropathic pain: a pilot study. Eur J Pain 8:377-383, 2004.
Abstract | Wikistim Entry