Spinal Cord Stimulation

Spinal cord stimulation can help long-term pain that surgery and medicine have not fixed, like failed back surgery syndrome and CRPS. Every patient trials the device before any permanent implant, at Remix Medical in Houston, TX.

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By Raju Mantena, DO · Pain Medicine PhysicianReviewed Jul 9, 20262 min read

Key takeaways

Spinal cord stimulation delivers mild electrical impulses to the dorsal columns of the spinal cord through implanted epidural leads, modulating pain signals before they reach the brain — intervening in how the nervous system carries and amplifies pain rather than at the original injury site.
Every patient trials the device first: temporary leads are worn for 5 to 7 days at home, and only a successful trial — at least 50% pain reduction with functional improvement — leads to permanent implantation. This test-before-commit structure is the therapy's single best feature.
The best-supported indications are post-laminectomy (failed back surgery) syndrome and CRPS, with growing evidence for painful diabetic neuropathy; modern high-frequency and burst waveforms are often imperceptible, unlike the older tingling paresthesia.
A psychological evaluation is a standard, meaningful part of candidacy — untreated depression, active substance use, and unrealistic expectations predict poor outcomes — not a formality or a disqualification.
It's a management therapy, not a cure: realistic goals are substantial pain reduction, less opioid use, and restored function, with devices requiring maintenance and occasional lead revision.

Spinal Cord Stimulation in Houston, Texas

When pain has outlasted the injury, the surgery, and the medication, the problem is often no longer at the site of the pain. It is in how the nervous system carries and amplifies the signal. Spinal cord stimulation intervenes at that level.

What is Spinal Cord Stimulation?

A spinal cord stimulator is a small implanted device that delivers mild electrical impulses to the dorsal columns of the spinal cord, modulating pain signals before they reach the brain. It consists of thin leads placed in the epidural space and a generator implanted under the skin.

Modern systems are rechargeable, MRI-conditional, and use waveforms that most patients do not perceive at all.

Phase	What happens
Trial	A temporary device is worn for a few days to see how much it reduces your pain
Implant	If the trial clearly helps, a small permanent device is placed under the skin
Living with it	You adjust the settings with a remote; it can be turned off or removed

The Trial Comes First

No patient receives a permanent implant without a trial.

During a trial, temporary leads are placed percutaneously and connected to an external generator worn for five to seven days. The patient goes home and lives normally — works, sleeps, walks — while assessing the effect.

A trial is considered successful with at least 50 percent pain reduction and meaningful functional improvement. Only then is permanent implantation discussed.

This structure is the single best feature of the therapy. You find out whether it works for you before committing to it.

Best-Supported Indications

Post-laminectomy syndrome (failed back surgery syndrome) — the strongest evidence base
Complex Regional Pain Syndrome (CRPS)
Painful diabetic peripheral neuropathy
Chronic radicular pain not amenable to further surgery
Phantom limb pain
Refractory angina and critical limb ischemia

Honest Expectations

Spinal cord stimulation is a pain management therapy, not a cure. The realistic goal is substantial pain reduction, reduced opioid requirement, and restored function — not the elimination of all pain. Devices require maintenance, leads can migrate, and revision is sometimes necessary.

Psychological evaluation is a standard part of candidacy assessment, and it is not a formality. Untreated depression, unaddressed substance use, and unrealistic expectations all predict poor outcomes.

How it's performed

During the trial, the patient lies prone under fluoroscopy and thin electrode leads are advanced percutaneously into the posterior epidural space at the level that corresponds to the pain distribution. The leads exit the skin and connect to an external generator worn for 5 to 7 days. If the trial produces at least 50 percent pain relief and functional improvement, permanent leads and a pulse generator are implanted in a subsequent outpatient procedure and programmed over follow-up visits.

How to prepare

Complete the required psychological evaluation before scheduling. Nothing to eat or drink for 6 hours before the procedure. Arrange a driver. Hold anticoagulants as directed by the prescribing physician. Bring a list of implanted devices, including pacemakers and defibrillators. Plan for the trial period — you will keep a pain diary and avoid showering over the dressing.

What to expect after

During the trial, keep the dressing dry, avoid bending and twisting, and keep a daily pain and function diary — the diary determines whether you proceed. After permanent implantation, avoid bending, lifting over 10 pounds, and raising arms overhead for 6 weeks while the leads anchor. Attend all programming visits. Report fever, wound drainage, escalating pain, new weakness, or loss of bladder or bowel control immediately.

Outcome

In appropriately selected patients who pass a trial, spinal cord stimulation commonly produces sustained pain reduction of 50 percent or more, decreased opioid requirement, and improved function. It is a management therapy rather than a cure, and outcomes are strongest in post-laminectomy syndrome and CRPS.

Frequently asked

Spinal Cord Stimulation questions, answered

Do I try it before the implant?

Yes. You wear a temporary device for a few days to see how much it reduces your pain, and only if that trial clearly helps is a permanent device placed.

What is spinal cord stimulation?

It's a small implanted device that eases pain by sending gentle electrical pulses to the spinal cord. It's used for persistent nerve pain that hasn't responded to other treatments.

What conditions does spinal cord stimulation treat?

It's commonly used for persistent nerve pain after back surgery, CRPS, and certain neuropathies. Your doctor confirms you're a good candidate.

Does the device hurt or feel strange?

Most people feel a mild tingling or simply less pain, and modern devices can work without any noticeable sensation. You adjust the settings with a remote.

Is spinal cord stimulation reversible?

Yes. It can be turned off or removed, which is one reason the trial-first approach makes it a lower-risk option for chronic nerve pain.

Sources

References

Kapural L, Peterson E, Provenzano DA, Staats P. Clinical Evidence for Spinal Cord Stimulation for Failed Back Surgery Syndrome. Spine 2017;42(Suppl 14):S61–S66 — https://pubmed.ncbi.nlm.nih.gov/28405512/
Kapural L, Yu C, Doust MW, et al. Novel 10-kHz High-Frequency Therapy (HF10) Is Superior to Traditional Low-Frequency Spinal Cord Stimulation (SENZA-RCT). Anesthesiology 2015;123(4):851–860 — https://pubmed.ncbi.nlm.nih.gov/26218762/
Deer TR, Mekhail N, Provenzano D, et al. The Appropriate Use of Neurostimulation (Neuromodulation Appropriateness Consensus Committee). Neuromodulation 2014;17(6):515–550 — https://pubmed.ncbi.nlm.nih.gov/25112889/
Kaye AD, et al. Spinal Cord Stimulation. StatPearls. NCBI Bookshelf — https://www.ncbi.nlm.nih.gov/books/NBK553154/
Petersen EA, Stauss TG, Scowcroft JA, et al. Effect of High-frequency Spinal Cord Stimulation on Painful Diabetic Neuropathy (SENZA-PDN). JAMA Neurol 2021;78(6):687–698 — https://pubmed.ncbi.nlm.nih.gov/33818600/
National Institute of Neurological Disorders and Stroke: Pain — https://www.ninds.nih.gov/health-information/disorders/pain

SpecialtyPain ManagementTypeProcedureBody locationEpidural space, dorsal columns of the spinal cord, thoracic spine, cervical spineCPT code63650 (percutaneous implantation of neurostimulator electrode array, epidural); 63685 (insertion or replacement of implanted neurostimulator pulse generator); 63661/63662 (removal of electrode array); 63663/63664 (revision); 95970-95972 (electronic analysis and programming)

Also called SCS, Neuromodulation, Dorsal Column Stimulation, Spinal Cord Stimulator, Neurostimulator

This page is for general education and is not a substitute for medical advice. Whether a given procedure is appropriate depends on your individual evaluation. Contact a Remix Medical clinician to discuss your care.

Updated July 9, 2026. Medically reviewed by Raju Mantena, DO.