title: Current challenges in spinal cord stimulation.
abstract: OBJECTIVE
  This study aims to review the current state of spinal cord stimulation for the treatment of chronic pain associated with failed back surgery syndrome (FBSS) and complex regional pain syndrome (CRPS) and to describe intraspinal targets and stimulation parameters, patient selection, therapy cost-effectiveness, and strategies to improve outcomes.
  
  
  METHODS
  We drew on professional literature spanning four decades, our work with national and international professional societies, and our own extensive clinical experience to summarize contemporary knowledge of the safety, efficacy, cost-efficiency, and challenges associated with spinal cord stimulation in treating chronic pain.
  
  
  RESULTS
  The safety, efficacy, and cost-efficiency of spinal cord stimulation in treating chronic pain associated with FBSS and CRPS are well established through randomized controlled trials and long-term observational studies. Challenges include reducing wait-times before implant, which are associated with lower success rates; increasing awareness of this therapy among referring physicians, patients, and payers; decreasing device-related complications by incorporating advanced technology, improved operative and trialing techniques, and appropriate patient selection; and capturing functional and quality-of-life outcomes. Spinal cord stimulation must be part of an overall treatment plan to manage chronic pain, and must engage physicians, patients, their families, pharmacists, nursing staff, and mental health experts in supporting a return to employment, if possible, and to a full domestic and social life.
  
  
  CONCLUSIONS
  Innovation in spinal cord stimulation therapy has intensified with numerous new technical capabilities, safety advances, and novel stimulation targets. This progress holds hope for the many sufferers of chronic pain.
authors: Section of Neurosurgery, Department of Surgery, Regina General Hospital, University of Saskatchewan, Regina, SK, Canada.
authors: Krishna
authors: K
authors: Kumar
authors: David L
authors: DL
authors: Caraway
authors: Syed
authors: S
authors: Rizvi
authors: Sharon
authors: S
authors: Bishop
mesh_terms: D059350:Chronic Pain / Q000209:etiology / Q000628:therapy*; D020918:Complex Regional Pain Syndromes / Q000628:therapy*; D016208:Databases, Factual / Q000706:statistics & numerical data; D006801:Humans; D010149:Postoperative Pain / Q000628:therapy*; D062187:Spinal Cord Stimulation / Q000379:methods* / Q000592:standards / Q000639:trends
keywords: Chronic pain; complex regional pain syndrome; failed back surgery syndrome; net monetary benefit; quality adjusted life years; spinal cord stimulation