Opioid analgesics are often prescribed, despite the lack of clinical evidence supporting their long-term use in the management of chronic pain. The current standard of care for chronic, noncancer pain typically includes many disciplines with the clinician developing an individualized treatment plan with the options of utilizing surgical interventions, pharmacology, and psychological and physical therapies. Literature supports a multidisciplinary approach as the standard of care, although various health care systems may not always support this concept consistently. Management of chronic pain varies greatly between nations and even within nations. 3 When chronic pain occurs, it has the potential to become disease itself, and subsequently, chronic pain has emerged as a distinct phenomenon. 1 – 4 This represents a profound impact on individuals and their families alongside the sizeable burden on employers, health care systems, and society in general. Overall, scientific literature demonstrates SCS to be a safe, effective, and drug-free treatment option for many chronic pain etiologies.Ĭhronic pain affects up to 20% of the population in developed nations. A number of variables have been identified that can affect SCS efficacy: implanter experience, appropriate patient selection, etiologies of patient pain, existence of comorbidities, including psychiatric illness, smoking status, and delay to SCS implant following pain onset. The body of evidence built on traditional SCS research may be redundant, with newer iterations of SCS therapies such as dorsal root ganglion SCS, high-frequency SCS, and burst SCS. Although only limited evidence exists for burst stimulation, there is now Level I evidence for both dorsal root ganglion SCS and high-frequency SCS that demonstrates compelling results compared with traditional therapies. More than half of all patients with chronic painful conditions experience sustained and significant levels of pain reduction following SCS treatment. Already, high-level evidence exists for the safety, efficacy, and cost-effectiveness (Level I–II) of traditional SCS therapies in the treatment of chronic refractory low back with predominant limb pain (regardless of surgical history). Recent developments will undoubtedly expand the applicability of SCS, allowing more effective and individualized treatment for patients, and may have the potential to salvage patients who have previously failed neuromodulation. New SCS technologies are being used increasingly in the clinical environment, but often there is a lag period between the clinical application and the publishing of high-quality evidence on safety and efficacy. Spinal cord stimulation (SCS) applications and technologies are fast advancing.
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