Key Learning Points

• Although spinal stimulation has been in existence for 40 years, the lack of suitable controls (patient, electrical, paresthesia, sensation) has hampered the performance of randomized trials.

• The mechanism of action of neurological stimulation appears to include gate control systems at the spinal level, as well as changes in neurotransmitter modulation of neural function.

• Technological advances in stimulation leads and battery power sources have made virtually any neurological site a potential target for neuromodulation.

• Spinal stimulation for the multiple operated back and radicular pain has been buoyed by a recent key randomized trial comparing stimulation to reoperation. Likewise, spinal stimulation for intractable angina pectoris is best supported by published trials.

• Due to the difficulty with sham controls, and resulting evidential problems, interventional pain physicians should develop best practice approaches to safety to limit adverse events from implantation of these devices.

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