For people throughout Newark and the surrounding Delaware area living with chronic low back pain, the path to this point is often a long one. Physical therapy, medication, injections, and in some cases prior surgery have all been tried, and the pain is still there, still limiting daily life, still making it hard to work, sleep, or simply move through a day without discomfort sitting at the center of it.
This is usually the point where spinal cord stimulation, often referred to as SCS, comes up as a possible next step, and it is a genuinely different kind of treatment than most of what came before it.
Spinal cord stimulation is not a medication and it is not a fusion or decompression surgery. It is a device-based therapy that works by changing how pain signals are processed before they ever reach a person's conscious awareness.
Understanding what that actually means, who tends to be a reasonable candidate, what the process of trying it actually looks like, and what realistic expectations should be, is worth working through carefully before deciding whether it is the right next step for a specific person's pain.
Spinal cord stimulation involves a small device, similar in concept to a pacemaker, that is placed under the skin and connected to thin wires called leads, which are positioned near the spinal cord in the epidural space.
The device delivers mild electrical pulses through these leads, and those pulses interfere with the way pain signals travel from the body to the brain. Traditional stimulation is often felt as a mild tingling sensation, sometimes described as a gentle buzzing, in the area where the pain has been occurring, though newer stimulation patterns, including higher-frequency and burst stimulation options, are designed to reduce pain without producing that tingling sensation at all.
The underlying idea, generally referred to as the gate control theory of pain, is that certain types of nerve stimulation can effectively close a kind of gate in the spinal cord, reducing the volume of pain signals that make it through to the brain.
This does not eliminate the underlying source of pain, whether that is nerve damage, scar tissue from a prior surgery, or another chronic condition, but for many patients it meaningfully reduces how much of that pain is actually experienced day to day.
It is worth being clear that spinal cord stimulation is generally considered when other, less invasive treatments have already been tried without adequate relief. It is not typically a first-line treatment, and most patients who end up as candidates have gone through a meaningful trial of physical therapy, medication management, and often injections or other interventional procedures before SCS becomes part of the conversation.
Spinal cord stimulation is most commonly considered for people dealing with chronic neuropathic pain, meaning pain that originates from nerve dysfunction or damage rather than from an acute, actively healing injury.
Failed back surgery syndrome, a term used to describe persistent pain after one or more spine surgeries that did not resolve the original pain or created new pain, is one of the most common reasons people are referred for SCS evaluation.
Chronic radiculopathy, which involves pain radiating from the spine into the leg due to nerve root irritation or compression, is another common indication, as is complex regional pain syndrome and certain other chronic nerve-related pain conditions.
Good candidacy typically depends on more than just the type of pain a person has. A thorough medical history, imaging review, and often psychological evaluation are standard parts of the workup, since the psychological evaluation helps identify whether there are underlying factors, such as untreated depression or significant unresolved psychosocial stress, that might affect how well a person responds to the therapy or how they cope with a chronic pain condition more broadly.
This is a standard part of the process at most reputable pain clinics and is not a sign of skepticism about a patient's pain, but rather a recognition that chronic pain and mental health are deeply connected, and addressing both gives a patient the best chance at a genuinely successful outcome.
People with pain that is primarily mechanical or structural in nature, such as pain driven mainly by significant spinal instability that would be better addressed surgically, are generally not ideal candidates for stimulation alone, which is part of why a careful diagnostic workup matters before moving forward with this treatment path.
One of the most important things to understand about spinal cord stimulation is that it is not an all-or-nothing decision made in a single visit.
Before a permanent device is implanted, patients go through a trial period, typically lasting somewhere around a week, during which temporary leads are placed through a minimally invasive needle procedure, without any permanent hardware implanted, and connected to an external device that the patient wears.
During this trial, the patient goes about a modified version of normal daily activities and tracks how their pain responds to the stimulation.
This trial period exists specifically so that patients and their physician can assess real-world effectiveness before committing to a permanent implant, and it is generally considered a meaningful predictor of how well the permanent system is likely to work.
A trial that produces a significant reduction in pain, commonly defined as at least fifty percent improvement, along with a meaningful improvement in function, is typically viewed as a good indicator that permanent implantation is likely to be worthwhile.
A trial that does not produce meaningful relief is valuable information as well, since it means a patient and their physician can reconsider other treatment paths without having gone through a permanent implant procedure first.
If the trial period shows meaningful benefit, the next step is a minimally invasive outpatient procedure to implant the permanent system.
This involves placing the leads in their final position, typically through a small incision, and connecting them to a small pulse generator that is implanted just under the skin, usually in the upper buttock or abdominal area, depending on the specific device and patient anatomy.
Recovery from the implant procedure is generally shorter and less involved than recovery from spine surgery, though patients are typically asked to limit certain movements, particularly bending, twisting, and reaching overhead, for a period of time while the leads settle into position and the incision sites heal.
Most modern spinal cord stimulator systems include rechargeable batteries with a device lifespan of many years, and programming can typically be adjusted after implantation as a patient's needs change over time, without requiring another surgical procedure.
It is important to approach spinal cord stimulation with a clear, honest understanding of what it can and cannot do.
SCS is not typically described by physicians as a cure, and most patients should not expect complete elimination of pain.
Instead, the realistic goal for most patients is a meaningful reduction in pain intensity, commonly in the range of fifty percent or more, along with improved function, reduced reliance on pain medication, including opioids in many cases, and a better overall quality of life.
Results vary from person to person, and the specific type of pain condition, how long the pain has been present, and a range of individual factors all play a role in how much benefit a given patient experiences.
This is exactly why the trial period matters so much, since it gives a much more personalized and reliable indicator of expected benefit than statistics alone can provide for any individual patient.
Like any medical device and procedure, spinal cord stimulation carries risks that are worth understanding and discussing directly with a physician before moving forward.
These can include infection at the implant site, lead migration, meaning the leads shift slightly from their original position and reduce or change the stimulation effect, hardware malfunction, and in rare cases, more significant complications related to the implantation procedure itself.
Some patients also find the sensation of stimulation, particularly with traditional tonic stimulation, uncomfortable or simply not to their liking, which is part of why the trial period exists and part of why newer stimulation options that minimize or eliminate the tingling sensation have become more widely available.
It is also worth understanding that a spinal cord stimulator is a long-term commitment involving an implanted device, periodic follow-up appointments, and in the case of non-rechargeable systems, eventual battery replacement.
Discussing the full picture, including device maintenance, MRI compatibility considerations for the specific device being considered, and what happens if the device needs to be removed or adjusted down the line, is an important part of an honest, informed conversation before moving forward.
Before pursuing spinal cord stimulation, it is worth having a detailed conversation with a pain management specialist about several specific things:
A physician who takes the time to answer these questions thoroughly, rather than rushing through them, is generally a good sign of the kind of careful, individualized care that chronic pain treatment genuinely requires.
The trial period commonly lasts around five to seven days, though the exact duration can vary based on the specific patient and physician's approach, giving enough time to assess how pain responds to stimulation during normal daily activities.
The trial involves a minimally invasive needle-based procedure without permanent hardware. The permanent implant is a minimally invasive outpatient surgical procedure, but it is generally far less involved than open spine surgery such as a fusion.
Most patients should not expect complete pain elimination. The realistic goal is typically a meaningful reduction in pain, often fifty percent or more, along with improved function and quality of life, though individual results vary.
If the trial does not produce meaningful relief, the temporary leads are removed and no permanent device is implanted. This information helps guide the conversation toward other treatment options that may be a better fit.
Yes. Most modern systems allow programming adjustments after implantation as a patient's needs or pain patterns change over time, without requiring an additional surgical procedure.
No. While failed back surgery syndrome is a common reason for SCS, it is also used for other chronic neuropathic pain conditions, including certain types of radiculopathy and complex regional pain syndrome, depending on individual evaluation.
This article is intended for general educational purposes and is not a substitute for personalized medical advice. Whether spinal cord stimulation is appropriate depends on an individual evaluation with a qualified pain management physician.
Chronic low back pain that has not responded to other treatments deserves a thorough, individualized evaluation before deciding on next steps, and spinal cord stimulation is one option worth understanding fully rather than ruling in or out without expert guidance.
The team at Delaware Spine & Interventional Pain, led by Dr. John Rowlands and Dr. Amir Kader, takes the time to understand each patient's full pain history and walk through whether SCS or another treatment path is the right fit.
Call us at (302) 366-2200 or visit delawarespineandpain.com to schedule a consultation at our Newark location, 774 Christiana Rd, Suite 201, Newark, DE 19713.
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