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

Patient Characteristics

Patient age

Does the patient's age affect the potential benefit of SCS? 

The safety and effectiveness of SCS in children remains to be established.

Age-related infirmity might reduce the chances of a good outcome with SCS, but each patient must be assessed on an individual basis.

Patient sex

Does the patient's sex affect the potential benefit of SCS?

Although investigators have reported differences in outcome for males and females, no reason exists to exclude patients based on their sex.

The safety of SCS during pregnancy remains to be established (and must be balanced against the known or potential adverse effects of medication and other treatments for pain).

Patient life expectancy

Life expectancy: An SCS system with an external stimulator might be more cost effective than an implanted generator in a patient (for example, one with terminal cancer) who has a very short life expectancy.

Age difference found

Burchiel KJ, Anderson VC, Wilson BJ, Denison DB, Olson KA, Shatin D. Prognostic factors of spinal cord stimulation for chronic back and leg pain. Neurosurgery 36(6):1101-1110, 1995.
Abstract | Wikistim Entry

No age difference found

May MS, Banks C, Thomson SJ. A retrospective, long-term, third-party follow-up of patients considered for spinal cord stimulation. Neuromodulation 5(3):137-144, 2002.
Abstract | Wikistim Entry

Kumar K, Toth C. The role of spinal cord stimulation in the treatment of chronic pain postlaminectomy. Curr Pain Headache Rep 2:85-92, 1998.

Kumar K, Toth C, Nath RK, Laing P. Epidural spinal cord stimulation for treatment of chronic pain--some predictors of success. A 15-year experience. Surg Neurol 50(2):110-120, 1998.
Abstract | Wikistim Entry

Kumar K, Hunter G, Demeria D. Spinal cord stimulation in treatment of chronic benign pain: challenges in treatment planning and present status, a 22-year experience. Neurosurgery 58(3):481-494, 2006.
Abstract | Wikistim Entry

Sex difference found

Woo-Sam J, Lo S, Wilemon W. Sex differences in adaptation to peripheral electrostimulating surgical implants. Arch Phys Med Rehabil 53(9):425-429, 1972.
Abstract

Sundaraj SR, Johnstone C, Noore F, Wynn P, Castro M. Spinal cord stimulation: a seven-year audit. J Clin Neurosci 12(3):264-270, 2005.
Abstract | Wikistim Entry

Shimoji K, Hokari T, Kano T, Tomita M, Kimura R, Watanabe S, Endoh H, Fukuda S, Fujiwara N, Aida S. Management of intractable pain with percutaneous epidural spinal cord stimulation: differences in pain-relieving effects among diseases and sites of pain. Anesth Analog 77:110–116, 1993.
Abstract | Wikistim Entry

North RB, Kidd DH, Zahurak M, James CS, Long DM. Spinal cord stimulation for chronic, intractable pain: experience over two decades. Neurosurgery 32(3):384-394, 1993.
Abstract | Wikistim Entry

North RB, Ewend ME, Lawton MA, Kidd DH, Piantadosi S. Failed back surgery syndrome: 5-year follow-up after spinal cord stimulator implantation. Neurosurgery 28(5):692-699, 1991.
Abstract | Wikistim Entry

North RB, Ewend ME, Lawton MA, Piantadosi S. Spinal cord stimulation for chronic, intractable pain: superiority of "multi-channel" devices. Pain 44(2):119-130, 1991.
Abstract | Wikistim Entry

Kupers RC, Van den Oever R, Van Houdenhove B, Vanmechelen W, Hepp B, Nuttin B, Gybels JM. Spinal cord stimulation in Belgium: a nation-wide survey on the incidence, indications and therapeutic efficacy by the health insurer. Pain 56(2):211-216, 1994.
Abstract | Wikistim Entry

Fiume D, Sherkat S, Callovini GM, Parziale G, Gazzeri G. Treatment of the failed back surgery syndrome due to lumbo-sacral epidural fibrosis. Acta Neurochir Suppl 64:116-118, 1995.
Abstract | Wikistim Entry

No sex difference found

Ohnmeiss DD, Rashbaum RF. Patient satisfaction with spinal cord stimulation for predominant complaints of chronic, intractable low back pain. Spine J 1(5):358-363, 2001.
Abstract | Wikistim Entry

Kumar K, Toth C. The role of spinal cord stimulation in the treatment of chronic pain postlaminectomy. Curr Pain Headache Rep 2:85-92, 1998.

Kumar K, Toth C, Nath RK, Laing P. Epidural spinal cord stimulation for treatment of chronic pain--some predictors of success. A 15-year experience. Surg Neurol 50(2):110-120, 1998.
Abstract | Wikistim Entry

Kumar K, Hunter G, Demeria D. Spinal cord stimulation in treatment of chronic benign pain: challenges in treatment planning and present status, a 22-year experience. Neurosurgery 58(3):481-494, 2006.
Abstract | Wikistim Entry