Spinal Cord Stimulations: Trial Procedures

Four leads have been inserted to test the efficacy of stimulation for this man with severe cervicogenic headaches.

One of the great attractions of spinal cord stimulation in the treatment of chronic pain is the ability to predict successful outcomes with a simple procedure of trial stimulation. One or more epidural needles are insert through the skin and the tips are brought to lie either within the epidural space or near a peripheral nerve of interest. Trial leads (special wires with multiple contact points) are then inserted through the needles and the needles are then removed. The leads are then affixed to the skin and connected to an external pulse generator.  During the stimulation trial, the patient is told to engage in normal activities for a period of between 2 days and 2 weeks to test the efficacy of the therapy. While the overall success rate of spinal cord stimulation and peripheral nerve stimulation is between 60 and 70%, if the trial itself is successful, the success rate of a permanently implanted system rises to over 90%. Another advantage derived from trial placements is the ability to test multiple different lead positions and then implant only the most efficacious ones.

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