Spinal Cord Stimulation (SCS) Therapy

1. What SCS Is and Who It Is For

What Is SCS?

The Basics

SCS stands for Spinal Cord Stimulation. It is an established treatment that has been used worldwide for decades.

In Simple Terms

SCS is a treatment that sends mild electrical signals to the spinal cord to relieve pain.

A small device, similar to a cardiac pacemaker, is implanted under the skin. Thin wires (called leads) carry gentle electrical pulses from this device to the area near the spinal cord.

When Is SCS Considered?

SCS is typically considered in three situations:

1. When the Cause of Pain Is Unclear or Not Surgically Treatable

• Conservative treatments (medications, injections, physical therapy) have been tried for months without improvement
• Imaging shows some narrowing or changes, but it's unclear whether these are the main cause of your symptoms
• The pain is primarily nerve-related, with little structural instability

SCS is considered when surgery cannot clearly address the source of pain.

2. When Surgery Is Possible, but Would Require a Major Procedure

• Multi-level spinal fusion (two or more levels) is needed
• Age or other health conditions make a large surgery risky
• Concerns about long-term complications of fusion (such as adjacent segment disease)

SCS may be proposed as an alternative to major surgery, or alongside it. The more levels that would need fusion, the stronger the case for considering SCS.

3. When Pain Persists After Surgery

• Surgery improved the structural problem, but nerve pain continues
• Reoperation is unlikely to help, or carries high risk

SCS is considered for persistent pain after spine surgery.

In all three cases, the leads and the generator are now most often implanted together in one operation. If you would like, a trial of about one week can be done first.

An important point:

SCS is not "giving up on surgery." When decompression surgery can solve the problem, we recommend decompression. When a single-level fusion is appropriate, we recommend fusion. But when multi-level fusion would be needed, or when surgical risk is high, SCS becomes a strong alternative. It is not a "last resort." It is a third option that deserves early consideration.

Who Is SCS Right For?

Three Patterns of Candidacy

1. When the Cause of Pain Is Unclear or Not Surgically Treatable

SCS may be considered as an alternative to surgery in these situations:

2. When Surgery Is Possible, but Would Require Major Fusion

Even when a treatable condition exists, the scale of the surgery and the patient's overall health may make SCS the better choice:

A note on considering SCS before surgery:

Traditionally, SCS was mainly used for pain that persisted after surgery. In recent years, more doctors recognize that when multi-level fusion would be needed or when surgical risk is high, SCS should be considered before proceeding to major surgery. This approach is supported by clinical experience and the latest evidence.

That said, treatment recommendations can vary between physicians and institutions. Please talk through your own situation with your doctor.

3. When Pain Persists After Surgery

Surgery vs. SCS — It's Not "Either/Or"

"If surgery can fix it, do surgery; if not, try SCS" is too simple.

In practice, the decision depends on what kind of surgery would be needed and the patient's overall condition.

A Treatment Framework Based on the Condition

Key points:

• SCS is not a "last resort"
• The more levels that would need fusion, the earlier SCS should be considered
• Decompression for patients who need decompression, single-level fusion when appropriate, and SCS as a "third option" before committing to multi-level fusion

When Surgical Risk Is High

Even when the surgical target is clear, SCS may be the better choice if:

• Advanced age makes general anesthesia or major surgery risky
• Multiple health conditions (diabetes, heart disease, lung disease, etc.)
• Blood-thinning medications cannot be safely stopped
• Multiple prior surgeries make reoperation high-risk

In these situations, trying SCS first, a lower-risk, reversible approach, can safely improve pain before more invasive options are considered.

When SCS Is Not Appropriate

Surgery is preferred over SCS when:

• Decompression alone can help (a clear, single-level compression that surgery can address)
• Structural instability is progressing (worsening slippage that requires stabilization)
• Severe spinal deformity is present (corrective surgery is needed)

SCS itself may not be suitable if:

• There is an active infection
• There is a bleeding disorder or blood-thinning medication that cannot be managed
• Pain is primarily related to psychological factors
• Another implanted device (such as a pacemaker) may conflict, which requires careful evaluation

How Your Doctor Makes the Decision

Your doctor considers three questions:

1. Can the cause of this pain be fixed with surgery? 2. If so, how extensive would the surgery need to be? 3. Can the patient safely undergo that surgery?

The answers guide the recommendation:

Timing Matters: "Not Too Early, Not Too Late"

When SCS is considered also matters:

Early consideration often leads to better outcomes.

2. How SCS Works and the Device

How SCS Works — Why It Relieves Pain

Blocking Pain Signals

Normally, pain travels along nerves to the brain.

Normal pain pathway: Pain signal --> Spinal cord --> Brain --> "Ouch!"

SCS sends electrical stimulation to the spinal cord, which interferes with pain signals on their way to the brain.

With SCS: Pain signal --> Spinal cord <-- Electrical stimulation --> Pain signals are disrupted, and pain is reduced

A Simple Analogy

It's similar to how rubbing a sore spot can ease the pain.

The rubbing sensation competes with the pain signals and partly blocks them. SCS works the same way: the electrical stimulation interferes with pain transmission.

The Science Behind It

Several mechanisms explain how SCS works:

1. Gate Control Theory: the stimulation "closes the gate" on pain signals
2. Neurotransmitter modulation: SCS increases the body's natural pain-relieving chemicals
3. Improved blood flow: stimulation may improve circulation in the affected area

The science is still developing, but many clinical studies have shown SCS to be effective in many patients.

About the Device

Components

The SCS system has two main parts:

The pulse generator connects to the leads, which are carefully positioned near the spinal cord.

Size

• Pulse generator: About half the size of a business card, and about 1 cm thick (non-rechargeable models are somewhat larger)
• Leads: About 1–2 mm in diameter

About the Devices

Several medical device manufacturers provide SCS systems, all approved by national regulatory authorities and covered by health insurance in Japan. Each device has its own features. Which one is best depends on your condition and your doctor's judgment.

To avoid endorsing any particular manufacturer or product, this website does not name specific manufacturers or models. We recommend asking your doctor directly which device they use, and why.

3. The Trial and the Permanent Implant

The Trial (Test Stimulation)

Testing Before the Implant

If you would like, SCS can be tested before the permanent implant. However, many people find it hard to judge the effect in such a short period, and the trial itself carries a risk of infection, so these days the leads and the generator are more often implanted together in one operation.

This is called a trial or trial stimulation.

Two Types of Trial

There are two approaches: a percutaneous trial (needle-based) and a surgical trial (open approach). The method used depends on the facility and physician.

Percutaneous Trial (Needle-Based)

The leads are inserted through a needle directly through the skin, without a surgical incision. The leads themselves exit through the skin and connect to an external stimulator for the trial period.

Surgical Trial (Open Approach)

A small incision (about 5–7 cm) is made to insert and secure the leads in a subcutaneous pocket. The leads remain inside the body, and only an extension cable exits through the skin at a separate site. This approach is designed with the permanent implant in mind from the start.

Comparing the Two Approaches

When a trial is done, the supervising physician of this website uses the surgical trial approach. The surgical trial is a slightly larger procedure, but the same leads are used for the permanent implant, so the benefit felt during the trial carries over.

The approach used varies by facility and physician. Please ask your doctor which method is used at your institution.

How the Trial Works

Based on the results:

• Effective (50% or greater pain reduction) --> Proceed to permanent implant
• Not effective --> The leads are simply removed (with virtually no lasting effect on the body)

Benefits and Drawbacks of the Trial

The Permanent Implant Procedure

After a Successful Trial

These days the leads and the generator are often implanted in a single operation, without a trial. When a trial has been done and it confirms that SCS works for you, the permanent implant procedure is scheduled.

With a surgical trial, the leads placed during the trial remain in place, and the pulse generator (battery) is added. With a percutaneous trial, the trial leads are removed, and entirely new leads and a pulse generator are implanted.

Anesthesia Options

Several anesthesia approaches may be used for SCS surgery:

The choice of anesthesia depends on the facility and physician's approach. If you have concerns about anesthesia, please discuss them with your doctor.

Hospital Stay

• Trial, if done: Approximately 1 week (varies by method)
• Permanent implant: Approximately 5–7 days (varies by facility)

Surgical Risks

Every surgical procedure carries some risk. The following complications have been reported with SCS. How often they occur depends on the facility, the device, and the patient's condition, so ask your doctor about your own situation.

Over the long term, the following may also occur:

The medical team works to prevent these complications, but no surgery is 100% risk-free. Weigh the risks of the procedure against the benefit of meaningful pain relief.

Post-Operative Rest

To prevent the leads from shifting, you will be asked to limit significant bending or twisting of the back after surgery. The duration of restricted activity varies by facility but is typically several days to one week.

4. Life After Implantation, Benefits, and Cost

Life After Implantation

Daily Activities

After SCS implantation, most everyday activities can be resumed.

Airport Security

The implant may set off metal detectors.

• Carry your patient identification card at all times
• Inform security staff that you have an implanted medical device
• You may be directed to additional screening

MRI Scans

Older SCS devices were not compatible with MRI. Newer models are MRI-compatible under specific conditions.

If you need an MRI, contact the hospital where your SCS was implanted for guidance.

Adjusting Your Stimulation

With SCS, you have direct control over your stimulation.

• A small handheld remote turns stimulation on and off
• You can adjust the intensity
• You can switch between pre-programmed settings

The medical team sets the stimulation strength and programs at the hospital together with you, and these adjustments are very important. On top of that, you can use the remote to match the day-to-day ups and downs of your pain.

What to Expect — Benefits and Limitations

Realistic Expectations

SCS does not eliminate pain completely.

A reduction of 50% or more is generally considered a successful outcome.

For example: If your pain is a "10 out of 10," SCS aims to bring it down to "5 or less." Reaching "zero" is uncommon.

What the Research Shows

Many studies have reported the following:

• Many people get pain relief, while some do not get enough benefit
• The benefit often lasts over the long term
• Medication doses can sometimes be reduced
• Quality of life improves

What SCS Can and Cannot Do

The Right Mindset

SCS is not a "cure." It is a tool for living better with pain.

The goal is not for pain to disappear entirely. It is for pain to no longer stop you from doing the things that matter to you.

Cost and Insurance Coverage

Insurance

SCS is an established medical treatment covered by health insurance systems in many countries, including Japan's National Health Insurance, the UK's NHS, and most private insurance plans in the United States, among others.

Coverage and out-of-pocket costs vary significantly by country and insurance plan.

General Cost Considerations

SCS involves costs for the trial procedure and, if successful, the permanent implant surgery. The total cost can be substantial before insurance, but most patients pay only a fraction of the full amount.

Reducing Out-of-Pocket Costs

Most healthcare systems have provisions to limit patient expenses for major procedures:

• In Japan: The High-Cost Medical Expense Benefit (高額療養費制度) caps monthly out-of-pocket costs by age and income, for example ¥85,800 + 1% of the bill for someone under 70 earning ¥3.7–7.7 million (from August 2026). See Treatment Costs and the High-Cost Medical Expense Benefit
• In the United States: Annual out-of-pocket maximums under most insurance plans, plus prior authorization processes
• In the UK: Covered by the NHS when clinically indicated

Contact your hospital's billing department or patient services office for cost information for your situation.

Finding an SCS Provider

SCS is a specialized treatment not available at every hospital.

It is typically performed at:

• University hospital departments of neurosurgery, orthopedic surgery, or pain management
• Specialized spine centers
• Pain management clinics

Ask your primary care doctor for a referral to a facility that offers SCS. A directory of SCS providers is currently being prepared.

5. Common Questions, Summary, and Next Steps

Frequently Asked Questions

Q. Does the electrical stimulation hurt?

A. It usually does not hurt. Most patients describe it as a gentle tingling or buzzing sensation. Some of the latest devices offer stimulation modes that you cannot feel at all.

Q. Can I take a bath?

A. Yes. Once your incision has fully healed, you can bathe and shower normally.

Q. How long does the device last?

A. The battery has a limited lifespan. For rechargeable models, how long the battery lasts depends on the device and on how the stimulation is delivered and how strong it is; for non-rechargeable models, battery life varies widely with the type and intensity of stimulation, and the generator often needs to be replaced within a few years. Replacement is a relatively minor procedure.

Q. What happens if it stops working?

A. The first step is to adjust the stimulation settings. If that does not restore the benefit, lead replacement or device removal may be considered. Removal does not have a significant impact on the body.

Q. Can I use a mobile phone or computer?

A. Yes, without any problems.

Summary

Read Next

Detailed SCS Guide: more on devices, stimulation types, and post-implant life

Treatment Comparison: compare SCS with surgery: cost, risk, and long-term outcomes

Preparing Mentally for SCS: psychological preparation before treatment

Tips for Daily Living: practical tips for living with chronic pain

Questions to Ask Your Doctor

Asking questions is not rude. It is part of good care.

You may think, "I should just leave it to the doctor." But you know your body best. Only you can tell the doctor where your pain is, how severe it is, and when it bothers you most. Asking questions leads to better care.

Here are some questions to bring to your appointment:

1. "Am I a candidate for SCS?"

   • Confirms whether SCS may be appropriate for you

2. "Will we do a trial, or implant everything at once?"

   • Helps you understand the approach, the reasons for it, and the treatment timeline

3. "Which manufacturer's device do you use, and why?"

   • Lets you understand the device choice and reasoning

4. "What is your success rate with SCS at this facility?"

   • Helps you evaluate the facility's experience

5. "If the trial doesn't work, what are my other options?"

   • Ensures there is a backup plan

6. "If I need an MRI in the future, will this device allow it?"

   • Confirms whether the device is MRI-compatible

7. "Do you use a percutaneous or surgical trial approach?"

   • Facilities use different methods, and knowing the pros and cons helps you prepare

8. "What type of anesthesia will be used?"

   • Local, sedation, or general anesthesia; approaches vary by facility

9. "What is the follow-up schedule after implantation?"

   • Helps you understand the ongoing care plan

Read more:

Detailed Question List for SCS Patients provides over 20 additional questions to consider.

Next Steps

If you are interested in learning more about SCS:

1. Talk to your primary care doctor
2. Ask for a referral to a facility that offers SCS
3. See a specialist for a thorough evaluation
4. Discuss whether SCS suits you, and how to proceed (implant at once or do a trial first)

A directory of SCS providers is currently being prepared. In the meantime, please discuss SCS with your doctor.

For Family Members

Thank you for reading this page. Watching a loved one live with chronic pain is difficult.

Here are ways you can help:

• Attend appointments together. You may be able to express concerns that your loved one finds hard to put into words
• Read this information together. Understanding the treatment options as a family helps with decision-making
• Create a safe space to talk about pain. Let them know it's okay to say "I'm hurting" without feeling like a burden
• Prepare questions together. Consider printing the question list above to bring to the appointment

This page provides medically accurate information, but individual diagnosis and treatment decisions should always be discussed with your physician.

The supervising physician has financial relationships with Medtronic and Boston Scientific. For details, see About This Site.