Practice Parameters for the Use of Spinal Cord Stimulation in the Treatment of Chronic Neuropathic Pain

Contraindications

Relative contraindications

What relative contraindications would reasonably cause a clinician to defer, delay, or modify the screening trial?

• An unresolved major psychiatric comorbidity
• The unresolved likelihood of secondary gain
• An active and untreated substance abuse disorder
• Inconsistency among the patient's history, pain description, physical examination, and diagnostic studies
• Abnormal or inconsistent pain ratings
• A predominance of non-organic signs (e.g., Waddell's signs)
• Alternative therapies with a risk/benefit ratio comparable to that of SCS remain to be tried
• Pregnancy
• Occupational risk (e.g., employment requires climbing ladders or operating certain machinery or vehicles)
• Local or systemic infection
• Presence of a demand pacemaker
• Presence of a cardioverter defibrillator
• Foreseeable need for an MRI
• Presence of a major comorbid chronic pain syndrome
• Anticoagulant or anti-platelet therapy

Absolute contraindications

What are absolute contraindications to SCS therapy? (See also medical contraindications in the section on patient management.)

• Inability to control the device
• For patients with a diagnosis of FBSS: nerve compression (e.g., disc, stenosis) amenable to surgery and causing a serious neurologic deficit and gross instability at risk for progression
• Coagulopathy, immunosuppression, or other condition associated with an unacceptable surgical risk
• Need for therapeutic diathermy

Contraindications are widely reported in descriptions of study designs.