Questions to Ask Before Spinal Cord Stimulation

A spinal cord stimulator is one of the most powerful tools we have in interventional pain medicine. It’s also a device that goes inside your body and stays there. Both of those things are true at the same time, and the gap between them is why patients deserve a clear, careful conversation before saying yes.

I’ve implanted a lot of stimulators. I’ve also told patients no — sometimes because they weren’t candidates, sometimes because we hadn’t tried enough simpler options first. Here are the questions every patient should bring to the consultation. If you’re seeing a pain physician anywhere — in Hoffman Estates, Schaumburg, the northwest Chicago suburbs, or elsewhere — these questions should be welcomed.

Am I actually a candidate, or is this a default recommendation?

Spinal cord stimulation has the strongest evidence for specific conditions: failed back surgery syndrome, complex regional pain syndrome (CRPS), painful diabetic peripheral neuropathy, and certain cases of refractory radiculopathy. It has weaker evidence — and more variable results — for non-specific axial low back pain alone.

If your pain pattern doesn’t match a strong indication, ask why the recommendation is being made. The honest answer might be that the doctor has had success with similar patients off-label. That’s defensible. But it’s a different conversation than “the literature strongly supports this for your condition.”

What does the trial period actually look like?

A spinal cord stimulator is one of the only major procedures in medicine where you get to test-drive the result before committing. Trial leads are placed percutaneously, you wear an external generator for about a week, and you live your normal life with the stimulator turned on.

The point of the trial is to see whether the stimulator gives you at least 50 percent pain reduction and lets you do things you couldn’t do before. If both happen, permanent implantation makes sense. If only the pain number drops but you’re not actually doing more, that’s worth a careful conversation.

Ask: how long is the trial, what activities do you want me to attempt during the trial, what counts as a successful trial, and what happens if the trial doesn’t work?

What waveform are you planning to use?

Modern spinal cord stimulators don’t all work the same way. The original technology was tonic stimulation — patients felt a tingling sensation (paresthesia) in the area of pain, and that sensation overrode the pain signal. The newer waveforms — high-frequency 10 kHz (Senza HFX from Nevro), burst stimulation (from Abbott), and various sub-perception programs — don’t produce paresthesia and have shown improved outcomes for certain pain patterns.

The right waveform depends on your pain pattern, your preferences, and your activity level. Ask which device and which waveform the physician is recommending, and why. There should be a specific answer, not a brand preference.

Who’s going to manage the stimulator after implantation?

This is the question patients forget to ask, and it matters more than they realize. A stimulator that isn’t programmed correctly is a disappointing investment. The post-implantation period — the first three to six months — is when programming gets refined, settings get adjusted, and the device gets dialed in to your pain pattern.

Ask: who handles programming, how often will I be seen during the first six months, and what happens if my pain pattern changes a year or two from now? Some practices have in-house representatives who do this; some rely entirely on the device manufacturer’s reps. Both can work, but the answer should be clear.

What happens if the stimulator stops working?

Stimulators don’t last forever. The leads can migrate, the battery (or rechargeable cells) can fail, the device can become less effective as the body’s nervous system adapts. Plan for this.

Ask: what’s the warranty on the device, what’s the typical lifespan, and what’s the process if it stops giving me relief in five years? You want to hear that there’s a plan, not surprise.

What are the realistic complication rates?

Spinal cord stimulation is generally safe, but it’s a procedure inside the spinal canal with a foreign body that stays implanted. The major risks include infection (around 2-3 percent in modern series), lead migration (more common), CSF leak (rare), and device-related complications.

Ask for the physician’s own complication rate, not the published rate. A physician who does many implants per year and tracks their outcomes should be able to give you a number. If they can’t, that’s worth noting.

Can I get an MRI later if I need one?

Most modern stimulators are MRI-conditional, meaning you can have an MRI under specific protocols. Older devices and some implant configurations limit MRI use. Ask specifically: what MRI capability does this device have? Can I have a brain MRI? Cervical, thoracic, lumbar? Is there any restriction?

This matters more than patients realize. If you develop a non-pain medical condition five years from now and need an MRI, you don’t want to discover a restriction at that point.

What are we doing if this doesn’t work?

This is the most important question I want patients to ask, and the one that’s most often skipped. If the trial fails, what’s the next step? If the implantation succeeds for two years and then declines, what’s plan B?

Good answers might include other neuromodulation modalities (DRG stimulation, peripheral nerve stimulation), targeted procedures we haven’t tried, or a frank conversation about other strategies including comprehensive pain rehabilitation programs. Bad answers are vague.

My approach in the Hoffman Estates practice

When a patient is potentially a candidate for spinal cord stimulation in my practice, the conversation usually takes more than one visit. I want to understand what’s worked and what hasn’t, what the patient’s daily life actually looks like, what realistic outcomes would change their life, and whether they understand the trial-and-permanent process.

The patient who’s going to do well with a stimulator is engaged, curious, and asking questions like the ones above. The patient I worry about is the one who wants me to make the decision for them. I won’t. The decision has to be the patient’s, made with eyes open.

If you’re in Hoffman Estates, Schaumburg, Palatine, Arlington Heights, Barrington, or anywhere in the northwest Chicago suburbs and you’re considering spinal cord stimulation, call (847) 981-3630 to schedule a consultation. Bring your imaging, bring your treatment history, and bring this list of questions. They’re the right questions to bring.

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Dr. Keith Schmidt is a triple board-certified interventional pain management physician in Hoffman Estates, Illinois. He performs spinal cord stimulation, DRG stimulation, peripheral nerve stimulation, and the full range of advanced neuromodulation procedures.