"Please complete all mandatory fields to determine eligibility for spinal cord stimulation therapy."
High-Integrity Patient Selection.
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Evaluating patients for Failed Back Surgery Syndrome (FBSS) or Complex Regional Pain Syndrome (CRPS).
Defending the authorization of a Spinal Cord Stimulator trial to insurance companies and boards.
Section 2
Literature
Development
SCS technology exploded in the 2000s, but early implementation suffered extremely high "explant" rates (devices removed because they didn't help). Functional neurosurgeons codified these criteria after learning painful lessons: SCS is fantastic for pure neuropathic (nerve) pain but terrible for mechanical/axial (joint/bone) pain, and terrible if the patient has untreated underlying psychological distress.
Section 3
Pearls/Pitfalls
Psych Clearance
The psychological clearance is not a mere formality. Chronic pain inherently induces psychological distress, but untreated somatoform disorders or secondary-gain (worker's comp) scenarios heavily predict a "failed trial" regardless of how perfectly the leads are placed.
