Spinal cord stimulation (SCS) continues to be a solid option for people dealing with chronic pain that just will not budge with the usual approaches like medications, physical therapy, or injections. It is a minimally invasive way to deliver low-level electrical pulses through electrodes placed in the epidural space near the spinal cord, helping to change how pain signals reach the brain and often providing relief in areas like the back, legs, or neuropathic zones. Recent systematic reviews and network meta-analyses of randomized trials back up its place in chronic pain care. A comprehensive 2026 review that combined direct and indirect evidence from multiple studies showed that different forms of SCS consistently outperformed usual medical management in lowering pain intensity, with average reductions ranging from 2.37 to over 5 points on a 0 to 10 scale across follow-ups up to 24 months (based on low-certainty evidence from 15 trials with 1,479 participants). The percentage of people getting at least 50 percent pain relief was much higher with SCS than with conservative care alone, and there were clear improvements in health-related quality of life (moderate certainty) and, in some cases, physical function (low certainty). These benefits appeared across various stimulation methods, suggesting the approach works broadly rather than one version being clearly better than the rest.
Real-world experience lines up with those findings. In large clinic series, about 80 to 85 percent of patients see enough relief during the temporary trial to move forward with permanent implantation, and most who get the full system keep meaningful improvement over months to years. A good number also end up using fewer opioids, which fits with the bigger goal of cutting back on long-term medication use. It tends to work especially well for things like persistent spinal pain after surgery, diabetic neuropathy, and certain neuropathic conditions, though results depend on factors like how long the pain has been present and other health issues. Choosing the right patients and following a careful process makes a big difference. Typically, candidates have had chronic pain for at least 6 months, have tried and not gotten relief from conservative treatments, and do not have major reasons it would not be safe. The trial phase, where leads are placed externally for 1 to 2 weeks, is the best way to predict who will benefit long-term. If it works well during the trial, the permanent system goes in, with regular tweaks to keep the coverage comfortable and effective. Risks like lead movement, infection, or hardware problems do happen, and about 10 to 15 percent of people eventually have the system removed (often because the relief fades or complications arise), but serious issues are uncommon when it is done by experienced teams.
In California, SCS aligns with evidence-based guidelines for certain situations. The Medical Treatment Utilization Schedule (MTUS), based on ACOEM chronic pain recommendations, supports it for refractory neuropathic pain or failed back surgery cases once simpler options have been exhausted. Coverage usually requires proof of benefit from the trial phase and meeting guideline criteria, though in places like the Central Valley, getting approved and scheduling can take longer due to prior authorization or limited specialist availability. Overall, SCS offers a reversible, adjustable tool that can help restore function, lower medication needs, and give people a better shot at everyday life without pain running the show. It works best as part of a broader, patient-centered plan that includes shared decisions, clear expectations, and ongoing follow-up, rather than as a standalone solution. As more data comes in, it remains a reliable piece of the puzzle for managing tough chronic pain cases.
Kayvan Haddadan is a physiatrist and pain management physician, and president and medical director of Advanced Pain Diagnostic & Solutions, a multidisciplinary pain management practice in California that he founded in 2012. A physician and surgeon licensed by the Medical Board of California, he is double board-certified in pain medicine and physical medicine and rehabilitation. He is also certified in controlled substance registration through the DEA and serves as a qualified medical examiner through California’s Department of Industrial Relations Division of Workers’ Compensation.
Dr. Haddadan earned his Bachelor of Science degree from the College of Alborz in Tehran, Iran, and his medical degree from Shahid Beheshti University of Medical Sciences. He later received his Educational Commission for Foreign Medical Graduates certification in Philadelphia, completed an internship in medical surgery at Loyola University Medical Center’s Stritch School of Medicine in Illinois, and finished his residency in physical medicine and rehabilitation at the same institution. He completed his fellowship in pain medicine at California Pacific Medical Center’s Pacific Pain Treatment Center and also trained in medical acupuncture for physicians at the University of California, Los Angeles David Geffen School of Medicine.
Dr. Haddadan has contributed to 29 research publications across multiple specialties, including pain management, cardiology, pulmonology, endocrinology, gastroenterology, and infectious disease. His work has examined topics such as hyperlipidemia in high cardiovascular risk patients, hyperuricemia and gout management, type 2 diabetes and hypertension, chronic obstructive pulmonary disease and asthma therapies, influenza treatment, irritable bowel syndrome, and opioid related complications in chronic pain care. His research has also included clinical outcome studies in spinal cord stimulation and award-winning presentations on neuropathic pain management and neuromuscular disorders.
