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Spinal Cord Stimulation as Treatment for Complex Regional Pain Syndrome Should Be Considered Earlier Than Last Resort Therapy


  • Conflict of Interest: Lawrence Poree is a paid consultant for and holds stock options with Spinal Modulation Inc.

    Jason Pope is a paid consultant for St. Jude and Spinal Modulation. Jason Pope is a speaker for Medtronic and Jazz Pharmaceuticals.

    Robert Levy is a paid consultant for St. Jude, Medtronic, Spinal Modulation, Nevro, Bioness, and Vertos Medical.

    Elliot Krames is a paid consultant for Nevro and Spinal Modulation. Dr. Krames is a Medtronic stockholder.

    Timothy R. Deer consults for St. Jude Medical, Spinal Modulation, Bioness Inc., Nevro, Medtronic Neuromodulation, Jazz Pharmaceutical, Flowonix Inc., and Vertos Medical.

    Louise Schultz reported no conflicts of interest.

  • For more information on author guidelines, an explanation of our peer review process, and conflict of interest informed consent policies, please go to

Address correspondence to: Elliot Krames, MD, Pacific Pain Treatment Centers, 2000 Van Ness, Suite 402, San Francisco, CA 94109, USA. Email:



Spinal cord stimulation (SCS), by virtue of its historically described up-front costs and level of invasiveness, has been relegated by several complex regional pain syndrome (CRPS) treatment algorithms to a therapy of last resort. Newer information regarding safety, cost, and efficacy leads us to believe that SCS for the treatment of CRPS should be implemented earlier in a treatment algorithm using a more comprehensive approach.


We reviewed the literature on pain care algorithmic thinking and applied the safety, appropriateness, fiscal or cost neutrality, and efficacy (S.A.F.E.) principles to establish an appropriate position for SCS in an algorithm of pain care.

Results and Conclusion

Based on literature-contingent considerations of safety, efficacy, cost efficacy, and cost neutrality, we conclude that SCS should not be considered a therapy of last resort for CRPS but rather should be applied earlier (e.g., three months) as soon as more conservative therapies have failed.