Chronic nerve-related pain can continue even after medications, physical therapy, injections, or surgery have not provided enough relief. Spinal cord stimulation, or SCS, is a neuromodulation treatment that uses mild electrical signals to change how pain signals are processed before they reach the brain.
Spinal cord stimulation is different from a one-time injection because it uses an implanted system with leads placed near the spinal cord and a small pulse generator placed under the skin. Before a permanent system is implanted, patients typically complete a temporary trial to determine whether the therapy provides meaningful improvement for their individual pain and functional goals.
At Regenerative Spine and Pain Specialists, Dr. Zwade Marshall and Dr. Jennifer Xiong evaluate your diagnosis, previous treatments, symptoms, functional limitations, and trial response to determine whether spinal cord stimulation may be appropriate.
Request an Appointment or call (404) 618-0995 to schedule an evaluation at our Fayetteville, Marietta, or Atlanta office.
What Is Spinal Cord Stimulation?
Spinal cord stimulation is a form of neuromodulation used to manage certain types of chronic pain. The system delivers electrical stimulation through thin leads positioned in the epidural space near the spinal cord.
The leads are connected to a pulse generator that creates programmed electrical signals. These signals change pain processing within the nervous system and may reduce the intensity or intrusiveness of pain for appropriately selected patients.
Some stimulation programs may produce a tingling sensation called paresthesia, while other programming approaches are designed to work without a noticeable sensation. The experience depends on the device, programming, and individual treatment plan.
Spinal cord stimulation does not repair damaged nerves, reverse arthritis, or eliminate the underlying condition. The goal is to reduce pain enough to improve function, activity tolerance, sleep, rehabilitation, or quality of life.
An important advantage of SCS is that patients can try the therapy with temporary leads before deciding whether to proceed with permanent implantation.
Who May Be a Candidate for Spinal Cord Stimulation?
Your pain management provider may consider spinal cord stimulation when you have persistent neuropathic or spine-related pain that has not improved enough with less invasive treatment.
You may be evaluated for SCS if you have:
- Chronic pain that has persisted despite appropriate conservative treatment
- Neuropathic pain with burning, shooting, electric, or other nerve-related qualities
- Persistent back or leg pain after previous spine surgery
- Complex regional pain syndrome or another selected chronic neuropathic pain condition
- Pain that significantly limits activity, sleep, work, rehabilitation, or quality of life
- No untreated condition that would make implantation inappropriate
- Realistic goals and the ability to participate in device management and follow-up care
Evaluation commonly includes a review of your diagnosis, imaging, previous procedures, medications, surgical history, overall health, and treatment goals. A psychological or behavioral health evaluation is also commonly part of the pre-implant process and may be required by an insurance plan.
Spinal cord stimulation is not appropriate for every type of chronic pain. Your provider will determine whether the suspected pain mechanism and your overall clinical situation make SCS a reasonable option.
What Conditions Can Spinal Cord Stimulation Help Treat?
Spinal cord stimulation is most commonly considered for selected chronic pain conditions in which neuropathic pain is a significant component and other appropriate treatments have not provided enough benefit.
Persistent Pain After Spine Surgery
Some patients continue to experience chronic back or leg pain after one or more spine surgeries. This is sometimes called persistent spinal pain syndrome or failed back surgery syndrome. When additional surgery is not expected to address the pain source, SCS may be considered as part of a comprehensive treatment plan.
Chronic Neuropathic or Radicular Pain
Some patients have persistent nerve-related pain involving the back, legs, neck, or arms. Symptoms may include burning, shooting, electric, or radiating pain. The appropriateness of SCS depends on the diagnosis and whether the pain pattern is one that may respond to neuromodulation.
Complex Regional Pain Syndrome
Complex regional pain syndrome, or CRPS, can cause severe persistent pain along with changes in sensitivity, temperature, color, swelling, or movement. Spinal cord stimulation may be considered in selected patients when other treatments have not provided adequate relief.
Other Selected Chronic Pain Conditions
Spinal cord stimulation may also be considered for certain other chronic neuropathic pain conditions depending on the diagnosis, device indication, treatment history, and individual goals.
Because SCS is not appropriate for all causes of chronic pain, identifying the likely pain mechanism is an important part of determining whether a trial should be considered.
Spinal Cord Stimulator Trial vs. Permanent Implant
Spinal cord stimulation is generally approached in two stages: a temporary trial followed, when appropriate, by permanent implantation.
Spinal Cord Stimulator Trial
During the trial, temporary leads are placed in the epidural space and connected to an external stimulator. The system is programmed for your pain pattern, and you use it for a limited period while tracking pain, activity, sleep, medication use, and other treatment goals.
The purpose of the trial is not simply to see whether you feel any change. Your physician will evaluate whether the therapy provides meaningful improvement that justifies moving forward with an implanted system.
Permanent Spinal Cord Stimulator Implant
If the trial is considered successful and you choose to continue, a permanent system may be implanted. The leads are positioned near the spinal cord and connected to a pulse generator placed under the skin, commonly in the flank or buttock region depending on anatomy and device choice.
The permanent system can be programmed and adjusted over time. The exact device, lead configuration, stimulation pattern, battery type, and MRI conditions vary by system.
How Does Spinal Cord Stimulation Work?
Spinal cord stimulation changes the way pain-related signals are processed within the nervous system rather than directly treating the injured tissue itself.
Thin leads containing electrodes are positioned in the epidural space. The pulse generator sends programmed electrical signals through those electrodes. Your physician and device specialist can adjust stimulation parameters based on your pain pattern and response.
Modern SCS systems can use different stimulation patterns. Some produce a tingling sensation in the treated area, while others are designed to provide therapy without noticeable paresthesia.
The system typically includes:
- One or more leads with electrodes
- An implantable pulse generator for permanent therapy
- A patient controller or compatible device used to manage prescribed settings
- Programming performed by the clinical and device-support team
Rechargeable and non-rechargeable systems are available. Device selection depends on the therapy being considered, your anatomy, expected energy use, lifestyle, and other clinical factors.
What Happens During a Spinal Cord Stimulator Trial?
Before the trial begins, you will be positioned so your physician can access the appropriate area of the spine. The skin is cleaned, and local anesthetic is used at the procedure site. Sedation may be used depending on the clinical plan.
Using fluoroscopic image guidance, your physician advances one or more trial leads into the epidural space and positions them based on your pain pattern and the stimulation system being used.
The leads are connected to an external stimulator and programmed. You then use the trial system for a limited period while paying attention to changes in pain, function, sleep, activity tolerance, and other goals that matter to you.
You will receive instructions for protecting the temporary leads and keeping the trial site clean and dry. Bending, twisting, lifting, and strenuous activity may be restricted because movement can shift the leads.
At the end of the trial, the temporary leads are removed. Your physician reviews the results with you and discusses whether permanent implantation is appropriate.
What to Expect Before, During, and After Spinal Cord Stimulation
Before the Trial
Your care team will review your diagnosis, prior treatments, medications, medical history, imaging, and treatment goals. Additional evaluation may be needed to determine whether you are an appropriate candidate for neuromodulation.
Tell your provider if you:
- Take blood-thinning or antiplatelet medications
- Have an active infection, fever, or illness
- Have diabetes or another condition that may affect healing
- Have allergies to medications, adhesives, or contrast material
- Have a pacemaker, defibrillator, or another implanted electronic device
- Are pregnant or may be pregnant
- Have had recent changes in your health
Do not stop prescription medications unless the prescribing or treating clinician specifically instructs you to do so. Follow the office instructions regarding eating, drinking, medications, transportation, and preparation.
During the Trial
The leads are positioned with image guidance and connected to an external stimulator. You will receive instructions on how to use the trial system and what activities to avoid while the temporary leads are in place.
After a Successful Trial and Permanent Implant
If you proceed with permanent implantation, your care team will provide incision-care and activity instructions. Temporary soreness at the implant and lead sites is common.
Physical restrictions are important during early healing because excessive bending, twisting, stretching, or lifting can contribute to lead movement. Your specific restrictions and timeline will be provided by your care team.
Programming is adjusted during follow-up visits based on your response. The goal is to find settings that provide useful symptom control while supporting your functional goals.
Risks, Side Effects, and Safety Considerations
Spinal cord stimulation involves procedures near the spine and, for permanent therapy, an implanted medical device. Potential risks should be considered carefully before treatment.
Possible complications include:
- Infection
- Bleeding or hematoma
- Pain or discomfort at the lead or generator site
- Dural puncture and spinal headache
- Nerve injury or other neurologic complications
- Lead migration, fracture, or other lead-related problems
- Device malfunction or loss of effective stimulation
- Unwanted or uncomfortable stimulation
- Scar tissue or other tissue reactions
- Need for reprogramming, revision, battery replacement, or device removal
MRI compatibility varies by spinal cord stimulator system. Some devices are MR Conditional only when specific requirements are met, while other systems or device configurations may not be compatible with MRI. Always tell imaging providers that you have an implanted neurostimulator and follow the device-specific instructions.
Your physician will review the risks, alternatives, expected benefits, and device-specific considerations that apply to your individual situation.
How Is a Spinal Cord Stimulator Trial Evaluated?
The trial is used to determine whether spinal cord stimulation provides enough meaningful benefit to justify permanent implantation.
Your physician may ask you to track several measures rather than focusing only on a single pain score. These may include:
- Change in your usual pain
- Ability to walk, stand, sit, sleep, work, or participate in daily activities
- Improvement in rehabilitation or exercise tolerance
- Changes in medication use when clinically appropriate
- Whether the therapy covers or affects the symptoms you most want to improve
- Your comfort using and managing the system
The amount of improvement considered meaningful depends on your clinical situation, treatment goals, and applicable insurance requirements. A successful trial does not guarantee the same degree or duration of benefit after permanent implantation.
How Long Can Spinal Cord Stimulation Provide Benefit?
Spinal cord stimulation is designed as a long-term therapy, but the amount and duration of benefit vary from patient to patient.
Some patients maintain meaningful improvement for years, while others experience changes in pain, stimulation coverage, device performance, or treatment goals over time. Follow-up programming can sometimes improve therapy when symptoms or stimulation needs change.
Long-term management may include:
- Periodic programming adjustments
- Charging the system when a rechargeable device is used
- Monitoring the battery or pulse generator
- Evaluation if stimulation changes or pain returns
- Imaging or device checks when clinically appropriate
- Revision or replacement of system components when necessary
SCS is intended to help manage chronic pain rather than cure the underlying condition. Ongoing care may still include exercise, rehabilitation, medications, behavioral strategies, or other treatments.
Can a Spinal Cord Stimulator Be Adjusted, Replaced, or Removed?
Yes. A spinal cord stimulator is an adjustable implanted system, and long-term management can change over time.
The stimulation settings can be reprogrammed without surgery. If a rechargeable system is used, the patient charges the implanted battery according to the device instructions. Non-rechargeable generators eventually require replacement when the battery reaches the end of its service life.
Additional procedures may sometimes be needed if a lead moves, a component stops working, the generator needs replacement, pain patterns change, an infection develops, or the therapy no longer provides adequate benefit.
The system can also be removed when medically necessary or when a patient and physician decide that continued therapy is no longer appropriate.
Because MRI conditions and compatibility vary by system and component configuration, keep your device identification information and tell medical and imaging professionals about your implant before future procedures or scans.
What Happens If the Spinal Cord Stimulator Trial Does Not Work?
A trial that does not provide meaningful improvement can prevent you from undergoing a permanent implant that is unlikely to meet your goals. That information is useful even when the trial is not successful.
If the trial does not provide enough benefit, your provider may reassess the likely source and mechanism of your pain and review your previous treatments, imaging, and response to the trial.
Depending on your condition, the next step could include:
- Adjustments to medications
- Physical therapy or rehabilitation
- Additional diagnostic evaluation
- A different interventional pain procedure
- Evaluation for dorsal root ganglion stimulation when clinically appropriate
- Behavioral pain-management strategies
- Referral for surgical evaluation when appropriate
- Continued multidisciplinary chronic pain management
The goal is to use the trial response to guide the next decision rather than proceeding automatically to permanent implantation.
Why Choose Regenerative Spine and Pain Specialists?
Regenerative Spine and Pain Specialists provides comprehensive interventional pain management for patients with spine-related and chronic pain conditions.
Our physicians, Dr. Zwade Marshall and Dr. Jennifer Xiong, are Harvard-trained, double-board certified anesthesiologists and interventional pain management specialists.
Dr. Marshall is the founder and chief medical officer of Regenerative Spine and Pain Specialists and completed his anesthesiology residency and interventional pain management training at Harvard-affiliated Brigham and Women’s Hospital.
Dr. Xiong completed her anesthesiology residency and fellowship training in interventional pain management at Harvard Medical School’s Brigham and Women’s Hospital. Her approach emphasizes compassionate, patient-centered care focused on function and quality of life.
Our approach to spinal cord stimulation includes:
- Individualized evaluation before recommending a trial
- Careful review of diagnosis, previous treatment, and functional goals
- Image-guided trial lead placement
- Temporary trial therapy before considering permanent implantation
- Programming and follow-up based on individual response
- Access to additional interventional options when SCS is not the right treatment
- Care focused on function and quality of life rather than promising a specific outcome
Spinal Cord Stimulation Care in Fayetteville, Marietta, and Atlanta
Regenerative Spine and Pain Specialists offers spinal cord stimulation evaluation and treatment through our offices in Fayetteville, Marietta, and Atlanta.
Fayetteville
Our Fayetteville pain management clinic is located at:
874 West Lanier Ave., Suite 250
Fayetteville, GA 30214
Marietta
Our Marietta pain management clinic is located at:
3939 Roswell Road, Suite 240
Marietta, GA 30062
Atlanta
Our Atlanta pain management clinic is located in Buckhead at:
371 E Paces Ferry Rd NE, Suite 802
Atlanta, GA 30305
Evaluation, follow-up, trial placement, and permanent implant scheduling may vary by location. Our team will let you know where each part of your treatment will take place based on your plan.
For questions about scheduling, call (404) 618-0995 or contact Regenerative Spine and Pain Specialists.
Frequently Asked Questions About Spinal Cord Stimulation
A spinal cord stimulator is a neuromodulation system that delivers programmed electrical stimulation through leads positioned near the spinal cord. The goal is to change pain processing and reduce certain types of chronic pain.
SCS may be considered for selected chronic neuropathic and spine-related pain conditions, including persistent pain after spine surgery, chronic nerve-related pain, complex regional pain syndrome, and certain other pain conditions when less invasive treatment has not provided enough benefit.
No. Patients typically complete a temporary SCS trial before permanent implantation. The trial allows you and your physician to evaluate whether the therapy provides meaningful improvement before deciding whether to implant a permanent system.
The trial is performed for a limited period that allows you to evaluate the therapy during daily activities. The exact duration and follow-up schedule vary by clinical plan, device, and insurance requirements.
If the trial provides meaningful improvement and you choose to continue, your physician may recommend permanent implantation. The permanent system includes implanted leads and a pulse generator placed under the skin.
It depends on the programming and system. Some stimulation patterns produce a tingling sensation called paresthesia, while other approaches are designed to provide therapy without a noticeable sensation.
SCS is designed as a long-term therapy, but long-term benefit and device lifespan vary. Rechargeable and non-rechargeable systems have different battery-management needs, and some components may eventually require replacement or revision.
Yes. A spinal cord stimulation system can be removed when medically necessary or when a patient and physician decide that continued therapy is no longer appropriate. Removal requires another procedure.
Potential complications include infection, bleeding, dural puncture, nerve injury, pain at the implant site, lead migration or breakage, device malfunction, uncomfortable stimulation, and the need for revision, replacement, or removal.
MRI compatibility depends on the exact device, leads, implanted configuration, and scanning conditions. Some systems are MR Conditional only under specific requirements. Always tell the imaging facility that you have an implanted neurostimulator and follow the device-specific MRI instructions.
If the trial does not provide meaningful improvement, the temporary leads are removed and permanent implantation is generally not pursued. Your provider can reassess your pain and discuss other treatment options.
Regenerative Spine and Pain Specialists offers spinal cord stimulation evaluation and treatment through our Fayetteville, Marietta, and Atlanta, Georgia locations. The location of evaluation, trial, implantation, and follow-up may vary, and the scheduling team will confirm the appropriate location for each step.
Schedule an Appointment for Spinal Cord Stimulation Evaluation
Chronic neuropathic or spine-related pain can affect sleep, mobility, work, exercise, and everyday activities. If your symptoms have continued despite appropriate conservative and interventional treatment, spinal cord stimulation may be one option to consider.
Dr. Zwade Marshall and Dr. Jennifer Xiong can evaluate your diagnosis, previous treatment, imaging when appropriate, and functional goals to help determine whether an SCS trial or another treatment better fits your condition.
Request an Appointment online or call (404) 618-0995 to schedule with Regenerative Spine and Pain Specialists.
Patients can also review our financial options or contact our office with questions before scheduling.