Health Problem: Neuropathic pain is defined as pain that is caused by a lesion or disease of the somatosensory system and is distinct from other pain conditions. The transmission of sensory information in the peripheral and central nervous systems can be profoundly impacted by these deleterious factors and result in perception of painful sensations generated by the nervous system itself. Prevalence estimates of neuropathic pain range from 1% to 17.9% based on American, European, and Asian studies.

Technology Description: Spinal cord stimulation (SCS) is achieved through the implantation of a stimulator device and electrodes near the spine. A subcutaneous pulse generator is connected directly to electrodes implanted in the epidural space (percutaneously or via surgical incision). Patients usually undergo a trial period of SCS before implantation of the device. SCS was developed as a treatment based on the gate control theory of pain, but its mechanism of pain attenuation is not clearly understood. SCS may lower sensory hypersensitivity and modulate the activity of small diameter fibers, while imaging studies suggest that centrally, SCS influences both perception of pain and emotional aspects of pain.

Controversy: Neuropathic pain is a notoriously difficult condition to treat with a wide variability in presentation, severity, and etiology. While some pharmacotherapies demonstrate efficacy, reliance on narcotic analgesics may put patients at risk for dependency. Surgical procedures, such as SCS, carry considerable risks associated with the trauma of the intervention itself and may not be appropriate unless conservative treatments fail. However, SCS may provide a treatment option for certain patients with chronic neuropathic pain for whom standard medical treatment has failed to provide relief, although it may not be effective for every patient.

Key Questions:

  • Does SCS improve pain, function, and/or quality of life (QOL) compared with standard medical treatment for neuropathic pain, including conventional medical management (CMM), reoperation, best medical therapy (BMT), and physical therapy (PT)?
  • Do modifications to standard SCS improve pain, function, and/or QOL?
  • Is SCS for treatment of neuropathic pain safe?
  • Have definitive patient selection criteria been established for the use of SCS for the relief of neuropathic pain?

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