Spinal cord stimulation for chronic pain syndromes: A review of considerations in practice management

Background: Chronic pain syndromes are clinically challenging to treat, and management with opioid medications is increasingly shown to be inappropriate and ineffective. Spinal cord stimulation (SCS) has been demonstrated across numerous high-quality and well-designed studies to be effective in treating various refractory chronic pain. The efficacy and overall success of SCS is highly dependent on compliance to and consideration of various practice patterns. Objective: This manuscript is intended to compile and present comprehensive recommendations for key SCS management principles including: a) patient selection criteria, b) efficacy of SCS for various conditions, c) discussion of SCS waveforms, d) trial and permanent implantation considerations, e) periprocedural management, and f) complications and adverse events. Study Design: An evidence-based narrative review. Methods: PubMed, Medline, Cochrane Library, prior systematic reviews, and reference lists were screened by 2 separate authors for all randomized trials, meta-analyses, and observational studies relevant to each of the aforementioned management principles and considered for study inclusion. Results: All high-level evidence studies that explored the various facets of SCS practice management were included for review. Limitations: Both continued investigation into, and practice implementation of, the various facets of SCS management are necessary to optimize patient outcomes. Conclusion: Implementation of and adherence to the evidenced-based recommendations delineated in this publication may help optimize efficacy outcomes and maintain safety profiles for persons treated with SCS interventions.