Spinal Cord Stimulation
If selected chronic neuropathic pain has not improved with appropriate treatment, spinal cord stimulation may offer a trial-first, reversible option. At Spine & Pain Specialists of the Carolinas in Charlotte, North Carolina, interventional pain medicine specialist Aashish Jay Kumar, MD, D.ABA evaluates the diagnosis, prior care, function, goals, and risks before recommending a trial.
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How it works at a glance
Trial the therapy before an implant decision
Temporary epidural leads and an external generator are used first. Programmed signals modify pain processing, and a permanent system is considered only after meaningful trial benefit.
Illustrative only — not to scale. Anatomy and procedural approach vary by patient.
01
Evaluation
02
Screening
03
Temporary trial
04
Review response
05
Implant if selected
What is spinal cord stimulation?
Spinal cord stimulation (SCS) is an implanted neuromodulation therapy. Thin leads are positioned in the epidural space and connected to a pulse generator that delivers programmed electrical signals. The goal is to modify pain processing and improve daily function; SCS does not repair the underlying condition.
A trial comes before an implant decision
Temporary leads connected to an external generator allow you and Dr. Kumar to measure changes in pain, function, sleep, medication use, and patient-specific goals before considering permanent implantation.
Who may be considered for spinal cord stimulation?
Candidacy is individualized. SCS is generally considered after an appropriate diagnosis and a reasonable course of less invasive treatment. Potential candidates may include carefully selected patients with chronic neuropathic pain such as persistent spinal pain after surgery, complex regional pain syndrome, or other conditions for which neuromodulation is supported after specialist evaluation.
The evaluation may include:
- Review of symptoms, examination, imaging, prior procedures, surgery, rehabilitation, and medications
- Specific functional goals that can be measured during a temporary trial
- Medical and psychosocial screening, including expectations and ability to manage the system
- Discussion of reasonable alternatives, including continued non-implant care
What happens during the SCS process?
1
Comprehensive evaluation
Dr. Kumar reviews the pain diagnosis, examination, imaging, prior treatment, functional goals, medications, comorbidities, and procedural risk.
2
Pre-trial preparation
Education, medical optimization, and required psychosocial screening are completed. Device choices, infection prevention, restrictions, and alternatives are discussed.
3
Temporary trial
Leads are placed using image guidance and connected to an external generator. You track meaningful changes during the trial period.
4
Shared decision
Pain relief, function, medication use, tolerability, and goal attainment are reviewed. Permanent implantation is considered only when the overall trial is meaningful.
5
Implant and follow-up
If selected, permanent leads and a generator are implanted. Wound care, activity restrictions, programming, and long-term device follow-up are essential.
What are the potential benefits and limitations?
Potential benefits
- Reduced selected chronic neuropathic pain
- Improved walking, sleep, activity, or rehabilitation participation
- Reduced reliance on some pain medications in selected patients
- Programmable therapy that can be adjusted over time
Important limitations
- SCS is not a cure for the underlying condition
- A successful trial does not guarantee long-term benefit
- Relief can be incomplete or diminish over time
- Revision, replacement, or removal may eventually be required
What are the risks of spinal cord stimulation?
Risks vary with your health, anatomy, medications, device, and procedure. They may include infection, bleeding or hematoma, lead migration or breakage, hardware discomfort, loss of benefit, dural puncture or spinal headache, need for revision or removal, device and MRI restrictions, and rare neurologic injury. This list is not exhaustive. Dr. Kumar reviews the individual risk profile and alternatives before any procedure.
Spinal cord stimulation frequently asked questions
What is a spinal cord stimulator trial?
A trial uses temporary leads connected to an external pulse generator. It allows you and your physician to measure changes in pain, function, sleep, and medication use before considering a permanent implant.
Does a successful trial guarantee long-term relief?
No. A useful trial improves patient selection, but it cannot guarantee the degree or durability of benefit after implantation. Outcomes vary, and benefit can diminish over time.
Will I feel tingling from spinal cord stimulation?
That depends on the programming and system. Some approaches produce paresthesia, while others are designed to operate without a noticeable sensation. Programming is individualized.
Can I have an MRI with a spinal cord stimulator?
Many current systems are MRI-conditional, but eligibility depends on the exact device, lead configuration, body region, scanner, and required settings. Always confirm with the implanting team and radiology department before MRI.
Is spinal cord stimulation a cure?
No. It is a reversible pain-management therapy intended to reduce selected pain and improve function. It does not repair the original structural or neurologic condition.z
Clinical references
- Shanthanna H, et al. Evidence-based consensus guidelines on patient selection and trial stimulation for SCS therapy. Regional Anesthesia & Pain Medicine. 2023. PubMed
- NICE Technology Appraisal 159. Spinal cord stimulation for chronic pain of neuropathic or ischaemic origin. Guidance
Educational information only. Individual evaluation is required, and outcomes cannot be guaranteed.
Is a spinal cord stimulation trial appropriate for you?
Schedule an evaluation with Dr. Kumar in Charlotte to review the diagnosis, prior care, expected benefits, alternatives, and complete risk profile.