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

Loss of Efficacy

How should loss of pain relief be managed?

When pain/paresthesia overlap is lost (with or without sign of electrode migration), first reassign contact combinations (anodes/cathodes/off); should this fail, the electrode might require revision.  When pain relief is lost despite appropriate pain/paresthesia overlap, treat with adjuvant medical therapy.

Strength of recommendation Evidence source(s)/rationale
B = Recommended
Uncertain validity, apparently useful
  • Weighing risk versus potential benefit and expert consensus reveals a good likelihood of a favorable outcome

Lang P. The treatment of chronic pain by epidural spinal cord stimulation - a 15 year follow up: present status. Axon 71-73, 1997.
Abstract | Wikistim Entry

Barolat G, Schwartzman R, Woo R. Epidural spinal cord stimulation in the management of reflex sympathetic dystrophy. Stereotact Funct Neurosurg 53(1):29-39, 1989.
Abstract | Wikistim Entry