Present and Potential Use of Spinal Cord
Stimulation to Control Chronic Pain
Authors: Song Jason J. 
Published: February 2021

Background: Spinal cord stimulation is an intervention that has become increasingly popular due
to the growing body of literature showing its effectiveness in treating pain and the reversible nature
of the treatment with implant removal. It is currently approved by the FDA for chronic pain of the
trunk and limbs, intractable low back pain, leg pain, and pain from failed back surgery syndrome. In
Europe, it has additional approval for refractory angina pectoris and peripheral limb ischemia.
Objective: This narrative review presents the current evidence supporting the use of spinal cord
stimulation for the approved indications and also discusses some emerging neuromodulation
technologies that may potentially address pain conditions that traditional spinal cord stimulation has
difficulty addressing.
Study Design: Narrative review.
Results: Spinal cord stimulation has been reported to be superior to conservative medical
management and reoperation when dealing with pain from failed back surgery syndrome. It has
also demonstrated clinical benefit in complex regional pain syndrome, critical limb ischemia, and
refractory angina pectoris. Furthermore, several cost analysis studies have demonstrated that spinal
cord stimulation is cost effective for these approved conditions. Despite the lack of a comprehensive
mechanism, the technology and the complexity in which spinal cord stimulation is being utilized
is growing. Newer devices are targeting axial low back pain and foot pain, areas that have been
reported to be more difficult to treat with traditional spinal cord stimulation. Percutaneous hybrid
paddle leads, peripheral nerve field stimulation, nerve root stimulation, dorsal root ganglion, and high
frequency stimulation are actively being refined to address axial low back pain and foot pain. High
frequency stimulation is unique in that it provides paresthesia free analgesia by stimulating beyond
the physiologic frequency range. The preliminary results have been mixed and a large randomized
control trial is underway to evaluate the future of this technology. Other emerging technologies,
including dorsal root ganglion stimulation and hybrid leads, also show some promising preliminary
results in non-randomized observational trials.
Limitation: This review is a primer and not an exhaustive review for the current evidence
supporting the use of spinal cord stimulation and precursory discussion of emerging neuromodulation
technologies. This review does not address peripheral nerve stimulation and focuses mainly on spinal
cord stimulation and touches on peripheral nerve field stimulation.
Conclusions: Spinal cord stimulation has demonstrated clinical efficacy in randomized control trials
for the approved indications. In addition, several open label observational studies on peripheral nerve
field stimulation, hybrid leads, dorsal root ganglion stimulation, and high frequency stimulation show
some promising results. However, large randomized control trials demonstrating clear clinical benefit
are needed to gain evidence based support for their use.
Key words: Spinal cord stimulation, chronic pain; low back pain, high frequency stimulation,
peripheral nerve field stimulation, dorsal root ganglion stimulation, failed back surgery syndrome,
complex regional pain syndrome, critical limb ischemia, refractory angina pectoris