Spinal Cord Stimulator Trials

For patients with chronic pain that has not responded to medications, physical therapy, injections, or surgery, spinal cord stimulation (SCS) offers a proven alternative that can dramatically reduce pain and improve function — without relying on opioids.

Dr. Edward Rubin performs spinal cord stimulator 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 spinal cord stimulator 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 the transmission of pain signals 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 technology has advanced dramatically. Today's systems offer rechargeable batteries, wireless programming, MRI compatibility, and sophisticated algorithms that adapt to position and movement in real time.

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, as psychological factors significantly affect outcomes.

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 allows you to test the therapy in your real life, performing daily activities, before committing to a permanent device.

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 the 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 (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

A successful trial is the single strongest predictor of long-term SCS success.

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 allows return home the same day or next 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 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, 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. The lead placement is done under local anesthesia with light sedation. You may feel pressure during the procedure, but significant pain is uncommon.

Can I have an MRI with a spinal cord stimulator? Many newer systems are MRI-conditional, meaning MRI can be performed under specific conditions. Dr. Rubin will review which system is best suited to your imaging needs.

Will I still need medications? Most SCS patients reduce — but may not eliminate — their medication needs. The goal is meaningful functional improvement and reduced medication burden, not necessarily complete elimination of all medications.

What if the stimulator stops working or I want it removed? The system can be reprogrammed at any time. The device can also be surgically removed; because no tissue is destroyed, removal is straightforward and pain typically returns to baseline.

Does insurance cover spinal cord stimulation? Medicare and most major commercial insurance plans cover SCS trials and implants when appropriate criteria are met. Our office handles prior authorization and works with your insurance company throughout the process.

Contact Us

If you have been told you are not a surgical candidate, or if surgery hasn't resolved your pain, a spinal cord stimulator trial may be your next step. Call 516-492-3100 or request an appointment below to discuss whether SCS is right for you.