Neural modulation by stimulation.

Spinal cord stimulation (SCS) for the treatment of neuropathic pain is supported by good-quality randomized controlled trials, prospective and retrospective case studies, and observational case series that confirm its efficacy and safety. SCS has been successfully used in various refractory neuropathic pain conditions, including failed back surgery syndrome (FBSS), neuropathic back and leg pain, and complex regional pain syndrome (CRPS) types I and II. According to the Harbour and Miller Scale (2001), the evidence for SCS in FBSS has been classified as grade B, while that for CRPS type I has been classified as grade A. Clinical evidence has shown that compared to conventional pain therapy, more than two-thirds of carefully selected patients treated with SCS achieved sustained pain relief of 50% or more, with minimal side effects. Many patients were able to reduce their analgesic consumption. Quality of life improved and the majority of patients were happy with their treatment; in some cases, patients were able to return to work. Trial stimulation, which is relatively inexpensive and completely reversible, provides predictive value for long-term efficacy and increases the cost-effectiveness of permanent implantation. Studies consistently report that over time, SCS is potentially cost saving to the healthcare system. At present, SCS is considered a "last resort" in the treatment of refractory neuropathic pain, yet evidence suggests that early intervention with SCS results in greater efficacy and, in the case of FBSS, should be considered before re-operation.