Spinal Cord Stimulator Trials

I recommend spinal cord stimulator trials for patients who have, in most cases, already tried everything else. That's not a figure of speech — by the time we're having this conversation, the typical patient has been through physical therapy, multiple injections, medications, and often one or more surgeries. The pain is still there.

What I want those patients to understand is that not responding to those treatments is not a failure on their part. Some pain conditions involve changes to the nervous system itself — the way pain signals are generated and transmitted becomes altered over time, in a way that pills and injections can't fully reverse. Spinal cord stimulation is designed specifically for that problem.

Dr. Edward Rubin performs SCS trials and works closely with surgical colleagues for permanent implants. His expertise in patient selection, trial design, and outcome evaluation ensures that only the right candidates proceed to permanent implantation.

How Spinal Cord Stimulation Works

The SCS system consists of a small pulse generator (similar in size to a pacemaker) and thin wires called leads, which are placed in the epidural space near the spinal cord. The device delivers mild electrical impulses that interfere with pain signal transmission to the brain.

Depending on the device and settings used, patients experience either:

• A gentle tingling sensation (paresthesia) that replaces the pain signal, or
• Paresthesia-free stimulation using newer high-frequency or burst waveforms — where no tingling is felt but pain relief occurs

Modern SCS systems offer rechargeable batteries, wireless programming, MRI compatibility, and sophisticated algorithms that adapt in real time to body position and movement.

Who Is a Candidate for SCS?

SCS is most effective for patients with:

• Failed back surgery syndrome — Persistent pain after lumbar or cervical spine surgery
• Complex Regional Pain Syndrome (CRPS) — Type I and Type II; SCS has the strongest evidence base for this indication
• Chronic neuropathic leg or arm pain — Radiculopathy, nerve injury, or post-surgical pain
• Peripheral vascular disease pain — Pain from reduced blood flow to the limbs
• Angina — Refractory chest pain from coronary artery disease in select patients
• Diabetic neuropathy — Refractory lower extremity pain

Candidates should have a clear diagnosis, realistic expectations, and have exhausted more conservative options. A psychological evaluation is typically required before proceeding — not as a barrier, but because psychological factors affect outcomes in meaningful ways, and this step protects the patient as much as anything else in the process.

The Trial Phase — What to Expect

Before permanent implantation, every patient undergoes a trial period — typically 5 to 7 days — during which temporary leads are placed and connected to an external pulse generator worn on the body. This is the most important step in the entire process.

The trial exists because no physician can predict with certainty who will respond. Roughly 30% of patients who complete an SCS trial do not go on to permanent implantation — either the relief wasn't adequate, or the lead position wasn't optimal for their anatomy. A trial that doesn't lead to an implant is not a failure. It means you have accurate information before committing to a permanent device, which is exactly what the trial is designed to produce.

During the trial:

• A brief outpatient procedure places the trial leads under X-ray guidance; no surgery is required
• You return home the same day and continue your normal activities
• You control stimulator settings via a handheld remote or smartphone app
• You track your pain levels and functional improvements in a diary

After the trial:

• You return to Dr. Rubin's office to remove the trial leads (a simple in-office procedure)
• We review your pain diary and outcomes together
• If you achieved ≥50% pain reduction during the trial, you are considered a responder and can proceed to permanent implantation

Permanent Implantation

Permanent implantation is performed by a surgical colleague at a local surgical center or hospital. The procedure is typically done under light sedation, takes 1–2 hours, and most patients return home the same day or the following morning. Dr. Rubin remains involved in your ongoing programming and management after implantation.

Success Rates and Outcomes

Multiple randomized controlled trials and long-term outcome studies support SCS for the conditions listed above. For failed back surgery syndrome, studies consistently show 50–70% of patients achieve ≥50% pain reduction at 2-year follow-up — far better than reoperation or continued medical management alone.

For CRPS, SCS is the most evidence-supported invasive treatment available, with long-term studies showing sustained benefit in the majority of implanted patients.

Frequently Asked Questions

Is the trial procedure painful? Most patients find it well-tolerated. Lead placement is done under local anesthesia with light sedation — you may feel pressure during the procedure, but significant pain is uncommon. Some soreness at the insertion site for a day or two afterward is normal.

Can I have an MRI with a spinal cord stimulator? Many newer systems are MRI-conditional, meaning MRI can be performed under specific parameters. Dr. Rubin reviews each patient's imaging history and anticipated future needs before selecting a device — if frequent MRI is likely in your case, that shapes which system we choose from the start.

Will I still need medications? Probably, but less of them. Most patients who respond to SCS reduce their medication needs significantly — particularly opioids — though not necessarily to zero. Reduction in medication burden, alongside improved pain and function, is how we define a successful outcome.

What if the stimulator stops working or I want it removed? The system can be reprogrammed at any time. If you want it removed — for any reason — the device can be surgically taken out. Because the procedure does not destroy tissue, removal is straightforward and pain typically returns to its pre-SCS baseline.

Does insurance cover spinal cord stimulation? Medicare and most major commercial insurance plans cover SCS trials and permanent implants when appropriate criteria are met. Our office handles prior authorization and coordinates with your insurance company throughout the process. If there are coverage questions, we address them early — before you've committed any time or out-of-pocket expense.

Contact Us

If surgery hasn't resolved your pain, or if you've been told you're not a surgical candidate, a spinal cord stimulator trial may be the right next step. Call 516-492-3100 or request an appointment below.