Clinical Question

Is spinal cord stimulation a safe and effective treatment for low back pain?

Evidence-Based Answer

When studied for up to six months, spinal cord stimulation likely does not improve pain, function, or health-related quality of life vs. placebo. When studied for up to 12 months, spinal cord stimulation and optimal medical management may slightly improve back function and reduce opioid use. It is also uncertain if spinal cord stimulation can improve outcomes in the immediate term (i.e., less than one month). The long-term adverse effects and complications of spinal cord stimulation have not been quantified and are not fully understood.¹ (Strength of Recommendation: B, inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

Chronic low back pain is the leading cause of years lived with a disability and the most common musculoskeletal problem worldwide.² Spinal cord stimulation involves surgically implanting a device in the lower back or trunk that generates electrical impulses and delivers them to the spinal cord via electrodes within the posterior epidural space.¹ The mechanism of action is not well understood but is thought to work using the gate-control theory of pain, in which activation of non-nociceptive nerve signals attenuate pain signals sent to and processed by the brain. Inhibition of sympathetic nervous system activation is also a proposed action. Preimplantation trials are typically performed with percutaneous leads to screen for a response. If a patient achieves at least 50% pain relief, spinal cord stimulation implantation may be considered. The average cost of spinal cord stimulation implantation is $30,000.¹