Device types, stimulation modes, life after implantation, and an eligibility checklist — everything you need to know about SCS.
For readers who want a closer look at SCS.
What You'll Learn
- Which type of SCS candidate you are (understanding the 3 patient types)
- Device types and how to choose
- The different stimulation modes
- Post-surgery life guide (detailed version)
- Frequently asked questions (with detailed answers)
- The latest SCS technologies
SCS may be appropriate for 3 groups of patients. Knowing which group you belong to makes the conversation with your doctor more useful.
| Feature | Explanation |
|---|---|
| Situation | You have not yet had spinal surgery |
| Pain characteristics | Mainly neuropathic pain (numbness, radiating pain) |
| Imaging findings | Imaging does not match your symptoms, or there are degenerative changes at multiple levels |
| Surgical assessment | You have been told "there is no clear surgical target" or "it is unclear whether surgery can help" |
| Role of SCS | A valid treatment option instead of surgery (not a compromise) |
| Timing | Best results within 6 months to 2 years after starting conservative treatment (before the pain becomes deeply chronic) |
| Feature | Explanation |
|---|---|
| Situation | There is a treatable condition, but it requires fusion at 2 or more levels |
| Patient factors | Advanced age or existing health conditions that increase surgical risk |
| Role of SCS | An alternative to surgery, or considered alongside surgery |
| Key point | The more levels that need fusion, the greater the potential advantage of SCS |
| Feature | Explanation |
|---|---|
| Situation | You have already had spinal surgery |
| Pain characteristics | Neuropathic pain continues after surgery |
| Imaging findings | Structurally improved on imaging, yet pain persists |
| Medical term | Post-surgical spinal pain syndrome (also called failed back surgery syndrome, or FBSS) |
| Role of SCS | An effective treatment for post-surgical pain (one of the best indications for SCS) |
| Timing | If pain continues 3 to 6 months after surgery |
These questions can help you find out:
"Have you had spinal surgery before?"
(If you have not had surgery) "Has your doctor told you that surgery is difficult, or that there is no clear surgical target?"
(If you have not had surgery) "Have you been told that fusion at 2 or more levels is needed?"
An important perspective:
All three types are legitimate candidates for SCS. For Type 1 patients, SCS is an effective treatment for neuropathic pain that surgery cannot address, not a fallback for when surgery is impossible. For Type 2 patients, the risks of multi-level fusion (adjacent segment disease, infection, prolonged hospitalization, etc.) need to be weighed against the benefits of SCS.
About considering SCS before surgery (the supervising physician's view):
Considering SCS as a primary treatment option before undergoing surgery (for Type 1 and Type 2 patients) is an approach based on the supervising physician's clinical experience and the latest medical evidence. For Type 2 patients who need multi-level fusion, the risk of complications after surgery rises with the number of levels fused, so SCS has a relatively greater advantage. This approach is gradually gaining recognition in Japan through the supervising physician's lectures and presentations, but it is not yet a standard treatment approach agreed upon by all medical institutions and physicians.
Approaches vary between hospitals and between doctors. Use this page as a reference and talk your options through with your own doctor.
Several manufacturers provide SCS systems in Japan. All are approved by the national regulatory authority and covered by health insurance.
Our editorial policy: To avoid endorsing any particular manufacturer or product, this website does not name specific manufacturers or models. Ask your doctor which device they use, and why.
The main differences between manufacturers and models come down to four points.
| Feature | What differs |
|---|---|
| Battery type | Rechargeable (longer battery life) vs. non-rechargeable (no charging routine) |
| Stimulation modes | All major devices offer both conventional and paresthesia-free programs (see Part 2) |
| Automatic adjustment | Adjustment based on body movement is available only on certain models |
| MRI compatibility | The conditions under which MRI scans are possible vary by model (see Part 4) |
About charging intervals:
How often a rechargeable device needs charging depends on several factors, including the device model and how the stimulation is delivered (type and intensity). Some people need to charge every day; others can go much longer between charges. Ask about the expected interval for your own case when choosing a device.
You charge over thin clothing such as an undershirt, with the charger held against the body by a corset-like belt. How long each session takes also depends on the device and how much charge remains.
All major devices offer programs both with and without paresthesia. The technology differs between manufacturers, but the types of stimulation available to patients are much the same. Only automatic adjustment based on body movement is limited to certain models.
Every device comes with a remote control for adjusting the stimulation yourself, and some models also work with smartphone apps.
All major devices are high quality, and the differences between them are small.
Important:
The choice of device matters less than your doctor's skill and experience. Choosing the device your doctor knows best usually makes the most sense. Try asking your doctor, "Which device do you use, and why?" (see the question list at the end of this page).
SCS stimulation has changed a great deal. The main approach used to be conventional stimulation, which "covers pain with a tingling sensation." Today, newer programs that produce no noticeable sensation are usually preferred.
This is the oldest method and is still an effective option.
| Feature | Details |
|---|---|
| Sensation | A tingling, buzzing, or vibrating feeling (paresthesia) |
| How it works | Covers the painful area with stimulation sensations |
| Advantage | Long track record; the effect is easy to feel |
| Effect on charging | Varies by device and settings |
These are now the main approach. They include high-frequency stimulation and several other technologies.
| Feature | Details |
|---|---|
| Sensation | Little to no stimulation felt |
| How it works | Acts on the pain signal processing itself |
| Advantage | Feels natural because there is no tingling; less interference with daily life |
| Effect on charging | Varies by device and settings |
This feature changes the stimulation strength to match your posture and activity.
| Feature | Details |
|---|---|
| How it works | Detects spinal cord electrical activity or body movement and adjusts automatically |
| Advantage | Stimulation stays at the right level whether you are standing, sitting, or moving around |
| Availability | Available on certain models (ask your doctor whether the device they use supports it) |
| Your situation | Recommendation |
|---|---|
| Receiving SCS for the first time | A paresthesia-free program is often tried first |
| Paresthesia-free program is not effective enough | Conventional stimulation is also tried |
| You are very active (bothered by stimulation changes) | A model with automatic adjustment |
In practice:
After implantation (or during the trial, if one is done), you will often try several modes to find the one that works best for you. Try both "programs with paresthesia" and "programs without paresthesia" before you decide.
| Timing | What to do | Notes |
|---|---|---|
| Day of surgery | Rest, vital sign monitoring | Do not push yourself to move |
| Day after surgery | Practice sitting up and standing | Watch for dizziness |
| Days 2-3 | Begin walking, stimulation adjustments | Some wound soreness is normal |
| Days 4-7 | Practice daily activities, adjustments | Avoid excessive bending or twisting |
| Discharge | Begin life at home | Follow your doctor's instructions |
| Activity | Allowed? | Notes |
|---|---|---|
| Bathing | Limited | Shower only until the wound is dry |
| Light housework | Yes | Do not lift heavy items |
| Desk work | Yes | Avoid sitting for long periods |
| Driving | Limited | Device makers and doctors advise switching stimulation off while driving. The final decision is yours |
| Exercise | No | Avoid vigorous exercise |
| Intimacy | Limited | Take care not to strain the wound |
| Activity | Allowed? | Notes |
|---|---|---|
| Bathing | Yes | As usual |
| Desk work | Yes | As usual |
| Physical work | Limited | Start with light tasks and gradually increase |
| Light exercise | Yes | Walking, stretching |
| Vigorous exercise | Limited | Consult your doctor |
| Travel | Yes | Take breaks during long trips |
Most activities become possible.
| Activity | Allowed? | Notes |
|---|---|---|
| Most sports | Yes | Contact sports require discussion with your doctor |
| Work | Yes | As usual |
| International travel | Yes | Carry your patient identification card |
| Golf, tennis | Yes | Once you are comfortable |
| Swimming | Yes | Once the wound is fully healed |
| What to avoid | Reason |
|---|---|
| MRI (without prior confirmation) | May affect the device |
| Strong electromagnetic fields | May affect the device |
| Strong impacts to the implant area | May cause the lead to shift |
| Traveling without your patient card | Required at airports and security checkpoints |
MRI (Magnetic Resonance Imaging) uses a very strong magnetic field and radio waves to make detailed images of the inside of your body. Unlike X-rays and CT scans, MRI does not use radiation, so repeated scans carry no radiation exposure. MRI is especially good at showing the spine and nerves in detail.
Because MRI uses very strong magnets, special precautions are needed if you have metal inside your body. Metal implants can cause these problems:
For this reason, metal objects are generally not allowed in the MRI room.
The SCS pulse generator (IPG) and leads contain metal, but each manufacturer uses special materials and designs to make its devices MRI-compatible. The major SCS devices currently on the market can undergo MRI scans under specific conditions.
Still, having an SCS does not mean you can get an MRI at any hospital without checking. Confirmation and preparation are always needed beforehand, because:
Current major SCS devices are "conditionally MRI-compatible."
| Feature | Details |
|---|---|
| 1.5T MRI | Most current models allow conditional full-body scanning |
| 3.0T MRI | Some of the latest models support conditional full-body 3.0T MRI. Many models currently support up to 1.5T |
| Scan duration | Limits apply (varies by model) |
| Pre-scan setup | Switching to MRI mode is required |
Key point: Even within the same manufacturer, the specific conditions for MRI scanning vary depending on the model number of the pulse generator, the type of lead, and the position of the lead. If you need an MRI, always confirm with the hospital where your SCS was implanted. When you go to the hospital, bring your SCS patient identification booklet and controller (remote). The booklet lists the model number and lead information, which the staff need to decide whether an MRI is safe.
| Step | What happens |
|---|---|
| 1 | An MRI scan is needed |
| 2 | Contact the hospital where your SCS was implanted |
| 3 | Confirm device information (model number, settings) |
| 4 | Provide this information to the MRI facility |
| 5 | Switch the SCS to MRI mode (if required) |
| 6 | The MRI scan is performed |
| 7 | After the scan, the SCS is returned to normal mode |
Q. What does the stimulation feel like?
A. It varies from person to person. Patients often describe it as:
With today's mainstream paresthesia-free programs, some people feel no sensation at all while their pain is relieved.
Q. Can the stimulation be too strong or too weak?
A. You can adjust it yourself with the remote control. Models with automatic adjustment also change the stimulation on their own as you change position or activity.
Q. Is the stimulation on 24 hours a day?
A. SCS is normally left on day and night, 24 hours a day. You can switch it off temporarily with the remote, for example while bathing.
Q. Can I use my phone or computer?
A. Yes. Everyday electronic devices do not interfere with the system.
Q. Can I use an induction cooktop (IH stove)?
A. Yes, but avoid leaning over the cooktop with the implant directly above it for long periods.
Q. Will I set off airport security gates?
A. You may trigger airport security gates. Show your patient identification card and explain the situation to the security staff. A hand-held metal detector check is not a problem.
Q. Can I use hot springs or public baths?
A. Yes, once the wound has healed. Avoid electric baths (low-frequency therapy pools).
Q. Can I drive?
A. Device makers and doctors advise switching stimulation off while driving. Beyond that, how much SCS affects safe driving, and whether to switch it off while driving, is ultimately your own decision. If you are unsure, talk with your doctor.
Q. How long does the battery last?
A.
When the battery runs out, a replacement surgery (a relatively minor procedure) is required.
Q. Is charging a hassle?
A. It depends on several factors, including the device model and how the stimulation is delivered (type and intensity). Some people need to charge every day; others can go much longer between charges. You charge over thin clothing such as an undershirt, with the charger held in place by a belt. Ask your doctor about the expected interval for your own case when choosing a device.
Q. Can the device malfunction?
A. Device-related problems do happen. In order of how commonly they are reported, they are: lead migration, lead fracture, infection, and hardware failure. With better devices and surgical techniques, these complications have shown a downward trend over the years. All of them can be dealt with by reoperation or programming adjustments.
Actual frequencies vary by device and by facility, so ask your doctor, "How often do these problems occur at this hospital?"
Q. Can the effect weaken over time?
A. The effect may fade over time (this is called habituation). If it does, the options are:
These steps often bring the relief back.
Q. Can I stop SCS treatment?
A. Yes. If the treatment does not work or you want to stop for any reason, the device can be removed. It leaves no significant lasting effect on your body.
| Technology | Description | Status |
|---|---|---|
| Paresthesia-free programs | Newer stimulation methods where you feel no tingling | In clinical use; now mainstream |
| Body movement tracking / automatic adjustment | Automatic optimization based on posture and activity | In clinical use |
| 3.0T MRI compatibility | Ability to undergo higher-field MRI scans | Partially available |
| Ultra-compact devices | Smaller pulse generators | In development |
| Battery-free systems | No charging needed | Research stage |
| AI optimization | AI-driven automatic tuning of stimulation settings | Research stage |
Check the items that apply to you:
How to interpret your results:
| Step | What to do |
|---|---|
| 1 | Talk to your primary care doctor: "I have been told that surgery is difficult (or that a large fusion is needed). I would like to learn about SCS as a treatment option." |
| 2 | Get a referral to a pain clinic or SCS specialist: a referral from your spine surgeon is preferred |
| 3 | Specialist consultation: reassessment of imaging and symptoms, determination of SCS candidacy, comparison with surgery (including weighing the risks of multi-level fusion against the benefits of SCS) |
| 4 | Decide how to proceed: these days the leads and generator are often implanted together; a trial (about 1 week) is available if you wish |
| 5 | After implantation: adjust stimulation settings; if the effect is limited, explore other options |
Advice for patients who have not had surgery:
SCS is an effective treatment for neuropathic pain in its own right, not just the option left when surgery is impossible. If multi-level fusion is needed, the risk of complications after surgery (adjacent segment disease, infection, etc.) rises with each added level, so compare it carefully with SCS. The best window for considering SCS is 6 months to 2 years after conservative treatment.
| Step | What to do |
|---|---|
| 1 | Talk to your spine surgeon: "My pain has continued after surgery, and I would like to learn about SCS." |
| 2 | Check whether reoperation is possible: confirm with imaging whether compression remains and whether reoperation would be effective |
| 3 | Get a referral to a pain clinic or SCS specialist: a referral from your spine surgeon is ideal |
| 4 | Specialist consultation: assessment of candidacy for post-surgical spinal pain syndrome, and an explanation of how to proceed (implant at once, or do a trial first) |
| 5 | Implantation: these days the leads and generator are often implanted together; a trial (about 1 week) is available if you wish |
| 6 | After implantation: adjust stimulation settings; if the effect is limited, explore other pain management approaches |
Advice for patients who have had surgery:
Post-surgical pain (post-surgical spinal pain syndrome) is one of the best indications for SCS. Some people find it suits them quickly; others take time to fine-tune the stimulation. Ask your doctor what degree of improvement you can realistically expect in your case. If your pain continues 3 to 6 months after surgery, consider SCS sooner rather than later.
Questions to discuss with your doctor when you are considering SCS:
"Which manufacturer's device do you use? Why?"
"For my situation, is a rechargeable or non-rechargeable device better?"
"How often will I need to charge the device? Is charging a burden?"
"For my case, are programs with paresthesia or without paresthesia more suitable?"
"Can I try multiple modes after implantation (or during a trial)?"
"In my case, which has a higher success rate -- surgery or SCS?"
"How long after conservative treatment should I consider SCS?"
"If I try SCS and it does not work, can I still have surgery afterward?"
"For patients like me with post-surgical pain, what is the success rate of SCS?"
"Is reoperation a possibility? Which is better for me -- SCS or reoperation?"
"After SCS implantation, can I get an MRI? Under what conditions?"
"What daily life restrictions will I have? (Work, exercise, travel, etc.)"
"If we do a trial, how should I judge whether SCS is working?"
"If the trial is not effective, what might be the reasons?"
"Will the trial use percutaneous (needle) leads or surgically placed leads? What are the pros and cons of each?"
"Will the procedure be done under local anesthesia, sedation, or general anesthesia?"
"How much will it cost? Can I use the high-cost medical care benefit system?"
"After implantation, how often will I need follow-up visits?"
Tip:
Print the checklist from Part 7 and bring it to your appointment. Asking "Which of the three types do I fall into?" usually gets you a more specific explanation from your doctor.
Comprehensive Questions for Your Doctor
Find an SCS Center Near You (日本語): search for facilities that perform SCS
Detailed Treatment Comparison: compare cost, risk, and long-term outcomes of SCS versus surgery
Treatment Selection Guide: finding the right treatment for you
SCS and Psychological Preparation: preparing yourself mentally before treatment
Daily Life Tips: practical ways to live well with pain
This page provides medically accurate information, but it is not a substitute for professional medical advice. Please consult your doctor for diagnosis and treatment tailored to your individual situation.