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

History

What aspects of an SCS candidate's medical history should be examined?

The specialist to whom the SCS patient is referred will review the patient's history pertaining to the neuropathic pain condition (e.g., for a patient with FBSS, operative records will provide critical information on the indications for any prior lumbosacral surgical procedure).  The history should include information on the patient's medications, allergies, and comorbid pain condition(s).

What position should SCS occupy on the treatment continuum?

SCS is a minimally invasive therapy. Thus, appropriate non-invasive therapies should have failed or be contraindicated before a patient undergoes an SCS screening trial.

Likewise, an SCS trial should precede ablative therapies (e.g., sympathectomies in CRPS patients) and major reconstructive procedures (e.g., reoperation in selected FBSS patients).

Does the number of prior procedures predict outcome?

Some investigators report that the success of SCS decreases as the number of prior interventions a patient has undergone increases and/or as the length of time since the onset of pain increases.