"Have You Heard of Spinal Cord Stimulation (SCS)?"

If pain persists despite treatment, there is a newer option you should know about.

Last week, we explored pain clinics and the multidisciplinary team approach. This week, we'll look at an option for people who haven't found enough relief from standard treatments: Spinal Cord Stimulation (SCS).

What Is SCS (Spinal Cord Stimulation)?

The Basic Idea

SCS is a treatment that places a thin electrode near the spinal cord and delivers gentle electrical impulses to reduce pain.

One simple way to picture it:

Imagine the electrical signals "closing a gate" before the pain message reaches your brain.

This idea comes from the "Gate Control Theory" of how pain signals travel.

How It Works in Practice

  1. The electrode (lead): A thin wire, just slightly thicker than a strand of hair, placed in the epidural space near the spinal cord
  2. The generator (IPG): A small device similar to a cardiac pacemaker, implanted under the skin of the buttock or abdomen
  3. The remote control: You can adjust the stimulation intensity yourself

The gentle electrical current from the electrode stimulates the spinal cord and reduces the pain signals traveling to the brain.

Who Is It For?

SCS does not suit every type of pain. It is meant for people who meet specific criteria.

Main Indications

  • Pain persists after spinal surgery (FBSS/PSPS)
  • Conservative treatments (medication, injections, rehabilitation) haven't given enough relief
  • Additional surgery isn't indicated, or you prefer not to have another operation
  • The source of pain is nerve-related

Where SCS Works Best

Effective Less Likely to Help
Leg pain and numbness Pure back pain alone
Post-surgical neuropathic pain Structural bone or joint pain
CRPS (Complex Regional Pain Syndrome) Pain primarily driven by psychological factors
Pain from peripheral vascular disease Acute pain

A Feature of SCS: It Can Be Undone

SCS does not cut or fuse bone, and if it does not suit you the device can be removed. If you would like, a trial (test stimulation) can be done before the permanent implant.

I still offer a trial to patients who want one. Many people find it hard to judge the effect in such a short period, and there is a risk of infection, so these days I more often implant the lead (electrode) and the generator (main unit) in a single operation.

If a Trial Is Done: How It Works

  1. Electrode placement (under local anesthesia, about 30 minutes to 1 hour)

    • Only the electrode is placed in the epidural space
    • The electrode is connected to an external device, and stimulation begins

  2. The evaluation period (approximately one week)

    • You stay in the hospital and go about near-normal activities while the effect is assessed
    • You record how much your pain improves
    • The stimulation settings are fine-tuned to find the best pattern for you

  3. The decision

    • If it works (pain reduced by 50% or more) --> proceed to permanent implantation
    • If it doesn't work --> the electrode is removed. Nothing remains in your body

"Try it, and if it doesn't work, it can be reversed." This is what makes SCS reassuring.

Permanent Implantation

If the trial confirms that SCS is effective for you, permanent implantation follows.

  • General anesthesia (or local anesthesia)
  • The electrode is permanently secured, and the generator (IPG) is implanted under the skin
  • Surgery time: 1 to 2 hours
  • Hospital stay: approximately one week

How Effective Is SCS?

Research Data

  • In studies of people with pain that persists after spine surgery, some patients' pain fell to half or less (results vary between studies)
  • Many patients are also able to reduce their medication use

Impact on Daily Life

Beyond pain reduction:

  • Improved walking distance
  • Better sleep quality (no more waking up in pain)
  • Increased activity levels
  • Lower medication doses (and fewer side effects)
  • Improved overall quality of life

Risks to Know About

Like any treatment, SCS has risks.

  • Results vary. Some people do not get enough pain relief.
  • Device problems happen at a certain rate. In order of how often they are reported: the lead moving out of position, a broken lead, infection, and a fault in the device itself. They are handled with another operation or by adjusting the settings.
  • Implantation is an operation. It carries the risks common to any operation, such as bleeding and wound pain.

If SCS does not suit you, the device can be removed.

How SCS Has Evolved

SCS technology has advanced a great deal in recent years.

Traditional SCS

  • Produced a tingling sensation (paresthesia) in the stimulated area
  • Worked by "replacing pain with a tingling feeling"
  • The sensation could change depending on body position

How SCS Technology Has Changed

There are now several ways of delivering stimulation, including methods you can barely feel. Which one suits you differs from person to person, so it is chosen together with your doctor.

MRI Compatibility

Many current SCS devices are MRI-compatible under certain conditions. This means you can still have MRI scans after implantation.

Frequently Asked Questions

Q: Will the pain go away completely?

A: Complete elimination of pain is uncommon. The goal is to reduce the pain by about half. Results vary from person to person.

Q: Does the device run constantly?

A: Stimulation generally runs 24 hours a day, but you can turn it on and off or adjust the intensity yourself with the remote control. Some patients turn it off temporarily during bathing, for example.

Q: How long does the battery last?

A: 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 stimulation settings; the generator often needs to be swapped (a minor surgery) within a few years.

Q: Can I fly on an airplane?

A: Yes, air travel is fine. At airport security, show the security staff your SCS identification card.

Q: Can I play sports?

A: Most sports are fine. However, intense twisting movements or contact sports may move the electrode out of place, so take some care.

Q: How much does it cost?

A: SCS is covered by health insurance in many countries. In Japan, it falls under the High-Cost Medical Expense Benefit system, which caps your monthly out-of-pocket costs based on income (see Week 10). In other countries, check with your insurer about coverage for neuromodulation therapies.

SCS Is Not a "Last Resort"

SCS used to be seen as "the thing you try when everything else has failed." That thinking has changed.

  • SCS is one of several options to consider at the right time

Want to Learn More About SCS?

The website hosting this column series, scs-for-lcs.com, has more detailed information about SCS.

  • How SCS works and the different types
  • The treatment journey from consultation to implantation
  • Frequently asked questions

If you're curious, please take a look.

To discuss whether SCS might suit you, speak with your surgeon or pain specialist.

Summary

  • SCS: A treatment that sends gentle electrical impulses near the spinal cord to relieve pain
  • Who it's for: Persistent pain after surgery, cases where conservative treatment hasn't worked
  • Feature: If unsure, you can try it first; if it does not suit you, it can be removed
  • Effectiveness: It eases pain; results vary from person to person
  • Risks: Device problems (lead movement, lead breakage, infection) and the risks common to any operation
  • Insurance coverage: Covered by health insurance in Japan and many other countries
  • Not a "last resort" but an option to consider at the right time