Expert answers to common spinal cord stimulation questions

It is important to know that SCS is not for everyone. 

Treatment teams – which may include, but are not limited to a pain specialist, pain nurse, physiotherapist, neurosurgeon and psychologist or psychiatrist – will work with individuals to determine the best treatment options to manage their chronic pain, and whether they are a suitable candidate for SCS. 

SCS is usually considered for moderate to severe pain when more conservative treatments have been trialed and are unsuccessful. Only eligible patients likely to benefit from SCS therapy are recommended for further evaluation through a trial, then potential implantation. 

If you have any questions about your individual situation, please speak to your treating healthcare professional or pain specialist.

A SCS device includes a small, implanted pulse generator, called a neurostimulator, and thin wires called leads which are implanted into the body.  An SCS device is similar to a pacemaker, in that it works by delivering tiny pulses of mild electrical stimulation – but instead of sending electric pulses to the heart, it directs them to nerves along the spinal column, interrupting pain signals before they reach the brain.

A remote control allows the patient to turn stimulation on and off, increase and decrease the level of stimulation, and target different pain areas in the body using settings or programs.

Placed in the region of a peripheral nerve, these stimulators target anatomical areas outside of the epidural space. Being away from the spinal cord, they serve a different function to SCS and can be used to treat other pain generating conditions like multifidus dysfunction. PNS may target the sensory or the motor nervous system and seek to either manage pain or restore function. (Examples of peripheral nerve stimulation include medial branch/isolated multifidus stimulation, cluneal nerve and vagal nerve stimulation).

There are generally two stages for patients for whom SCS is recommended. During a trial phase, which will typically last between three to seven days, an external stimulator and temporary or surgical leads can be used, to help a patient and their doctor decide if the therapy is a viable treatment option.²  

If the patient and treating doctor are happy with the improvements observed during the trial and the decision is made to proceed with the therapy, a pain specialist and/or neurosurgeon will perform a short procedure to insert the leads near your spinal cord (sometimes called the epidural space) and implant the neurostimulator under your skin (usually in the buttock area).²

SCS is not a cure for chronic pain – rather, it is an additional treatment option to help manage chronic pain. 

Research shows that around 80% of patients will experience some level of improvement in their pain as a result of SCS,³ and it has been shown to help reduce long-term reliance on opioids and other pain medications that have significant side effects.⁴

SCS can be an effective treatment for certain types of chronic pain.^3,5 

The goal of the treatment is to reduce pain at clinically meaningful levels by at least 50%. Research shows that around 80% of patients will experience approximately a 50% reduction in their pain as a result of SCS.³

Chronic pain is complex, and everyone experiences pain differently. It is important to know that not all patients will respond to SCS in the same way, and the amount of pain relief achieved will vary from person to person. 

Patient selection is a critical factor in determining the success of SCS, and all potential patients will be thoroughly assessed by their treatment team for suitability before SCS is recommended.

SCS is considered a safe, minimally invasive, and reversible procedure.^6,2

Every year around 50,000 people globally undergo SCS, and 11 clinical guidelines around the world endorse SCS as a treatment option for some chronic pain conditions.^7,8 

In Australia, SCS is approved by the Therapeutic Goods Administration. In the last five years, more than 6,500 Australians had a SCS device inserted.⁹

It is important to know that no procedure is without risk. While complications or adverse events are rare, there is a small chance of a minor or serious adverse event as a result of the procedure.

The most common serious adverse event from the implant procedure is an infection of the area where the device is implanted.⁴

While SCS is considered a safe and minimally invasive procedure, no procedure is without risk. It is important to know that while complications or adverse events are rare, there is a small chance of a minor or serious adverse event as a result of the procedure.⁴ 

The most common serious adverse event from the implant procedure is an infection of the area where the device is implanted.⁴ 

There is also a small risk of complications related to the device. The most common of these is lead migration, where the leads move away from their original location.⁴

Other possible complications include, but are not limited to⁴:

• pain at the implant site
• pain relating to the hardware
• muscular weakness
• electric shock
• sciatica and migraine.

In the last decade, SCS device technology – like many other areas of medicine – has improved. In addition to better pain management outcomes, studies show these advances have also resulted in less devices being removed.⁴ 

It is important to remember that SCS will not be the right treatment option for everyone. 

If you have questions about your personal situation, please speak to your treating healthcare professional or pain specialist.

Following the SCS trial procedure, you may experience some discomfort on your back where the leads were placed. This is temporary and should go away in the hours and days after the procedure. You might also experience some changes in stimulation intensity with certain activities during the trial stage, depending on what kind of device you choose. 

After the procedure for the permanent SCS implant, it may take you several weeks to recover and for the leads to settle into place. During this time, your doctor may advise that you avoid certain activities, including those that involve lifting, bending, and twisting. You may also experience pain at the neurostimulator implant site.

The system won’t be turned on until you’ve recovered.

SCS is endorsed as a treatment option for specific chronic pain condition by 11 clinical guidelines around the world, including the UK and the US. 

In 2022, the Therapeutic Goods Association (TGA) initiated a post-market review of all SCS devices available in Australia, to review the safety and performance of the devices. You can check the progress and outcomes of the review on the TGA’s website, which also includes a list of five questions to ask your health professional before you get a medical implant.

Please speak to your treatment team before driving. While some devices allow for this, there are many different SCS device models available, all of which will have their own specific guidelines and instructions.

You’ll be able to swim once your permanent SCS device has healed into place. You won’t be able to swim or bathe during your trial.

There are two main ways to differentiate SCS devices today. This first is the battery and the second is the type of stimulation:

Battery type:

• Non-rechargeable implantable pulse generator: These implants have a battery that needs to be replaced every 3 to 5 years. It may be a good option if you have a condition that only requires a small amount of electricity.
• Rechargeable implantable pulse generator: These implants have a battery that needs to be recharged regularly but usually lasts 10 to 15 years. They may be better if you have pain in multiple body parts that require more electricity to treat.

Stimulation type:

• Paresthesia based therapy: Traditional SCS therapy uses a low-frequency current to manage the pain sensation with a mild tingling feeling called paresthesia. 
• Paresthesia independent therapy: Requires no paresthesia (tingles) to be experienced by the patient.

Please speak to your treatment team before traveling. There are many different SCS device models available, all of which will have their own specific guidelines and instructions. 

In general, when going through airport security with a SCS device implanted, let them know you have an implanted neurostimulator. The security staff will then give you further directions. You will have an ID card to show that you have an implanted device, and you may be escorted around the security machine. Occasionally, they may insist that you go through the security machine. If this happens, you can turn your SCS off with the remote while passing through the machine and turn it on again once you are through security.

Research shows that SCS is a low risk, reversible procedure that has good long-term safety outcomes. It can improve your pain symptoms and help reduce long-term reliance on opioids and other pain medications that have significant side effects.^2,4,6

If a patient and doctor are satisfied with the performance of the SCS device, there is no need to have it removed, unless recommended by a doctor. 

If you have questions or are concerned about your SCS device, please speak to your doctor. They will listen to your concerns and work with you to find the best option for your individual situation.

SCS device implantation requires a trained clinician who specialises in neuromodulation procedures.

Generally, an SCS device implantation procedure is performed by a pain specialist and/or neurosurgeon.

Media coverage has driven significant concern among many patients living with chronic pain. We would encourage all patients with questions to speak to their healthcare professional.  

The safety and effectiveness of all medical devices used in Australia, including SCS devices, is rigorously monitored by the Therapeutic Goods Association. 

SCS device implantation requires a trained clinician who specialises in neuromodulation procedures and is supported by a multidisciplinary care team for ongoing management of the therapy.

If your doctor has recommended SCS as an option to manage your chronic pain, or if you have had a SCS device implanted, it is understandable that you may have questions or concerns about the therapy. All procedures carry a level of risk associated with them and should be evaluated against the benefits.

Your treating doctor is the best person to answer your questions, as they will be able to provide information and advice based on your individual situation.

If you have an SCS implant and think that it may not be working as it should be or are experiencing any unexpected side effects from the procedure, it is critical that you tell your doctor as soon as possible, so that it can be investigated further.

Importantly, research shows SCS has good long-term safety outcomes, can improve your pain symptoms, and help reduce long-term reliance on opioids and other pain medications that have significant side effects.⁴