Dr. Hiro K

Video 06

Is spinal cord stimulation right for you? Who does well, and who doesn't

For some people a spinal cord stimulator gives them their life back; for others it ends up being taken out. Who tends to do well, who needs more care, what the trial can and can't tell you, and the practical side before you decide.

In short

  • Nerve-type pain and a shorter time before the implant both point toward a better response.
  • Depression, smoking and long-term opioids are linked to removal: treat them first, they are not reasons to give up.
  • A trial is a good sign, not a guarantee. If a stimulator does not work, it can be taken out; it does not change how your spine moves.
  • About 1 in 4 people have at least one device problem, most often a lead moving. About 1 in 10 devices is removed over the years, most often because it stopped helping.
  • Ask: is my pain the type it helps, is there anything to treat first, what counts as success for me, what happens if it stops helping, and can I have an MRI with this system?

Summary

Stimulation works on the nerves, so it tends to help most when the pain feels like a nerve: burning, electric, shooting, tingling. Timing matters too. In a long-term study of about 400 people, the longer the pain had gone on before the implant, the less relief they got.

Depression, smoking and long-term opioid use have been linked to a higher chance that the device is removed. That is a link, not proof, and these are things you can work on before surgery. The psychological evaluation most US patients meet is not a pass-or-fail exam: its real value is finding what is worth treating first.

In a randomized trial in the UK, people who had a trial first and people who went straight to the permanent implant did about the same at six months and at three years, and the trial almost never caught the people who would go on to fail. A successful trial is a good sign, not a guarantee. Aim for half the pain, not zero.

Sources

  1. People whose questionnaires showed a strong nerve-pain pattern were more likely to respond to stimulation.

    Post-hoc analysis of a randomized trial, 125 people with back pain and no prior surgery, high-frequency stimulation. A PainDETECT score of 19 or more predicted a higher chance of pain response at 24 months. A co-author is from the device maker (Nevro).

    Kapural L, Wu C, Calodney A, et al. Demographics and PainDETECT as predictors of 24-month outcomes for 10 kHz SCS in nonsurgical refractory back pain. Pain Physician. 2024;27(3):129-139. PubMed 38506680

  2. The longer the pain had gone on before the implant, the less relief people got.

    410 patients followed over 22 years. Relief was inversely related to the time between the onset of pain and the implant. Long-term success overall: 74%.

    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. 2006;58(3):481-496. PubMed 16528188 · DOI

  3. Depression, smoking and long-term opioid use were linked to a higher chance that the device was removed.

    505 trials at one institution. Removal: 14.1%. Tobacco use, depression, chronic opioid use and falls predicted removal. No industry funding reported.

    Gheith R, Wortmann M, Najjar M, et al. Real-world outcomes of spinal cord stimulation: a consecutive institutional experience with 505 trials, trial-to-implant ratio, long-term efficacy, and explantation risk factors. J Pain Res. 2025;18:6381-6395. PubMed 41341898 · DOI

  4. Higher opioid doses before the implant were linked to more removals.

    US insurance claims data (MarketScan): people on higher opioid doses before the implant had their devices removed more often.

    Sharan AD, Riley J, Falowski S, et al. Association of opioid usage with spinal cord stimulation outcomes. Pain Med. 2018;19(4):699-707. PubMed 29244102 · DOI

  5. Psychological factors matter, but there is no evidence that screening on its own improves results.

    Review of 25 studies (4 on stimulation): 92% found at least one psychological factor linked to a poorer outcome. No study showed that screening itself improved outcomes.

    Celestin J, Edwards RR, Jamison RN. Pretreatment psychosocial variables as predictors of outcomes following lumbar surgery and spinal cord stimulation: a systematic review and literature synthesis. Pain Med. 2009;10(4):639-653. PubMed 19638142 · DOI

  6. Mood and fear of pain do matter, but no single questionnaire reliably predicts who will do well.

    Review of 29 studies. Fear and anxiety, catastrophizing and depression were only partly predictive and should not be used on their own to decide.

    Edelbroek C, Kallewaard JW, Huygen F, et al. Psychological determinants and predictors of outcomes in spinal cord stimulation: a systematic review. Pain Rep. 2026;11(3):e1429. PubMed 41948474 · DOI

  7. About two thirds to three quarters of people who try a stimulator in the US go on to a permanent implant.

    US insurance claims, 265,756 people who had a trial: 67% converted to a permanent implant, rising from 63.4% in 2010 to 73.3% in 2021.

    Day W, Maloy GC, Winter AD, et al. Spinal cord stimulator utilization trends and predictors of unsuccessful trial-to-implant conversion. N Am Spine Soc J. 2025;22:100616. PubMed 40548099 · DOI

  8. In a UK randomized trial, people who had a trial first and people who went straight to the permanent implant did about the same at six months, and the trial almost never caught the people who would go on to fail.

    105 patients with nerve-type pain. Pain score (0-10) at 6 months: 7.47 to 4.28 with a trial vs 7.54 to 4.49 without. Among people who would not go on to benefit, the trial screened out only 8%. Not cost-effective. Several authors consult for device makers.

    Eldabe S, Duarte RV, Gulve A, et al. Does a screening trial for spinal cord stimulation in patients with chronic pain of neuropathic origin have clinical utility and cost-effectiveness (TRIAL-STIM)? A randomised controlled trial. Pain. 2020;161(12):2820-2829. PubMed 32618875 · DOI

  9. Three years later, the two groups in that trial were still about the same.

    Responders at 36 months: 33% with a trial first vs 31% straight to implant. No difference in removals or adverse events. Some patients were lost to follow-up.

    Eldabe S, Nevitt S, Griffiths S, et al. Does a screening trial for spinal cord stimulation in patients with chronic pain of neuropathic origin have clinical utility (TRIAL-STIM)? 36-month results from a randomized controlled trial. Neurosurgery. 2023;92(1):75-82. PubMed 36226961 · DOI

  10. In one large US clinic, about three in ten patients still had at least 30% less pain at one year.

    Retrospective study at one large US clinic: 47 of 155 patients (30.3%) had at least 30% relief at 12 months. Psychological tests did not predict who would. One author reports research support from a device maker (Saluda).

    Botros M, Mekhail N, Costandi S, et al. Do psychological assessment tools predict spinal cord stimulation treatment outcomes? Reg Anesth Pain Med. 2026 (published online ahead of print). PubMed 42236127 · DOI

  11. About one in four people had at least one problem with the device; a lead moving out of place was more common than infection.

    Review of 33 studies, 3,445 patients. At least one adverse event: 24%; serious: 3%. Per 100 patient-years: lead migration 7.05, infection 2.82, removal 2.93. The studies varied widely.

    Raccagni NG, Dotti M, Goudarzi B, et al. Complication rates of spinal cord stimulation: a systematic review and meta-analysis. Neuromodulation. 2026;29(6):904-912. PubMed 42383966 · DOI

  12. About one in ten devices is removed over the years, and the most common reason is not infection but that the device stopped helping.

    Review of 25 studies: 9.82% of devices removed. Reasons: lack of benefit 38%, lead failure 15%, infection 14%. Several authors consult for device makers.

    Wahezi SE, Yener U, Naeimi T, et al. Spinal cord stimulation explantation and chronic pain: a systematic review and technology recommendations. J Pain Res. 2025;18:1327-1340. PubMed 40124536 · DOI

  13. Rechargeable systems usually need about an hour of charging every few days; most people are fine with it.

    50 patients: 80% satisfied with recharging, about 60 minutes every 4.2 days on average. A small study.

    Durand D, Garnier PH, Durand S, et al. Evaluation of the usability of the spinal cord stimulator recharging procedure in the treatment of neuropathic pain. A quantitative and qualitative study. Front Pain Res (Lausanne). 2026;7:1727882. PubMed 42199218 · DOI

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