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


Relative contraindications

What relative contraindications would reasonably cause a clinician to defer, delay, or modify the screening trial?

  • An unresolved major psychiatric comorbidity
  • The unresolved likelihood of secondary gain
  • An active and untreated substance abuse disorder
  • Inconsistency among the patient's history, pain description, physical examination, and diagnostic studies
  • Abnormal or inconsistent pain ratings
  • A predominance of non-organic signs (e.g., Waddell's signs)
  • Alternative therapies with a risk/benefit ratio comparable to that of SCS remain to be tried
  • Pregnancy
  • Occupational risk (e.g., employment requires climbing ladders or operating certain machinery or vehicles)
  • Local or systemic infection
  • Presence of a demand pacemaker
  • Presence of a cardioverter defibrillator
  • Foreseeable need for an MRI
  • Presence of a major comorbid chronic pain syndrome
  • Anticoagulant or anti-platelet therapy

Absolute contraindications

What are absolute contraindications to SCS therapy? (See also medical contraindications in the section on patient management.)

  • Inability to control the device
  • For patients with a diagnosis of FBSS: nerve compression (e.g., disc, stenosis) amenable to surgery and causing a serious neurologic deficit and gross instability at risk for progression
  • Coagulopathy, immunosuppression, or other condition associated with an unacceptable surgical risk
  • Need for therapeutic diathermy
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

Contraindications are widely reported in descriptions of study designs.