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In most cases, before a spinal cord stimulator is implanted permanently, a temporary stimulator is implanted for a trial period of several days to determine if the patient will experience a reduction in the level of pain. If good pain control is achieved during the trial period, the next step is the surgical implantation of a permanent spinal cord stimulator. Patients with implanted device often describe the sensation of the electrical current from the SCS as a "tingling" feeling, however, these sensations are far less bothersome compared to the pain associated with RSD.

There is no consensus regarding the timing of the initiation of SCS in the rehabilitation process of RSD. In 2002, an expert panel at the Cleveland Clinic Foundation published treatment guidelines in Pain Practice. In the guidelines, the panel recommended that interventional therapies such as SCS should be considered at early stages of therapy for some cases of RSD if it will help with advancing rehabilitation. It cannot be argued that the patient should have tried all conservative therapies before considering SCS and they should not have to wait as long as previously thought before being offered SCS as an option. In short, SCS should no longer be considered a last-resort treatment modality.

For more information about the report of this expert panel, please click on the following link: http://www.ncbi.nlm.nih.gov/pubmed/17134466

Spinal cord stimulators enable patients suffering from chronic RSD pain a means of better controlling their pain. Patients are usually able to resume their normal activities both at home and at work and also participate in recreational activities since the unit is portable. Although SCS is not a cure for chronic RSD pain, in many cases it can reduce the level of intensity of the pain and make it more manageable.

There are reports that many patients who undergo this procedure report a 50-70% reduction in pain or at least enough to become functional at work or lead an active life. A meta-analysis of the efficacy of spinal cord stimulation for RSD showed that it reduces pain, improves quality of life, enables some patients to return to work, and reduces the amount of medication taken by some patients.

To read more about this interesting finding, please click on the following link: http://www.ncbi.nlm.nih.gov/pubmed/16647590

Though some patients report successful control of pain in studies involving SCS compared to placebo groups, there is currently no absolute proof of efficacy. There is some indication that SCS may be effective in patients who have already undergone surgical sympathectomy. In addition, there are indications that a patient's positive response to a prior sympathetic nerve block may predict a good response to SCS. Spinal cord stimulation seems to produce analgesia without any reduction of sympathetic function.

Patients with RSD who may be considered as candidates for SCS include:

• Patients not making significant progress in rehabilitation with conservative therapy who will be able to exercise more effectively and participate in a more intensive rehabilitation protocol with increased control over pain