When spinal cord stimulation is used
Spinal cord stimulation is a surgical therapeutic method used to manage chronic pain by delivering low-level electrical currents to the spinal cord with an implanted medical device. Spinal cord stimulation requires spinal surgery and long-term commitment to living with implanted equipment. It is normally used when traditional treatments fail, and certain clinical criteria are met.
Funding criteria
The Drug and Therapeutics Advisory Committee met in October and December of 2024 to discuss funding for spinal cord stimulators for musculoskeletal conditions. Currently, no consistent criteria are applied for the funding of these devices at the WSIB. The committee reviewed information about spinal cord stimulators including current public sector funding status, the Ontario Health Technology Advisory Committee report and recent evidence-based consensus guidelines.
The Drug and Therapeutics Advisory Committee recommends that the WSIB approve funding decisions for the 10kHz high-frequency spinal cord stimulator, when the following criteria has been met:
- People with musculoskeletal injuries haven’t been successful with traditional medical management for a minimum of six months for any of the following conditions:
- failed back surgery syndrome
- complex regional pain syndrome
- diabetic neuropathy
- limb ischemia
- A multidisciplinary team in a hospital assess the patient’s suitability through regular follow-up appointments that could include:
- Pain Specialists
- Psychologists and/or Psychiatrists
- Neurosurgeons
- This team also completes the surgery.
- Before permanent placement for the device, there’s a trial of seven to ten days to ensure therapeutic benefit, including:
- paresthesia-based system – 80 per cent or more coverage
- pain-based symptoms:
- improved pain relief of more than 50 per cent
- if pain improvement is less than 50 per cent, a substantial improvement in function (greater than 50 per cent) or reductions on ongoing opioid use (greater than 50 per cent decrease)
Recommendation highlights
- A spinal cord stimulator is a medical device used to manage chronic pain, when other treatments haven’t been effective. It works by delivering low level electrical currents to the spinal cord through small electrodes implanted near the spine to disrupt pain signals traveling to the brain and reducing pain perception.
- The Ontario Health Technology Advisory Committee reviewed the effectiveness and safety of the 10kHz high-frequency spinal cord stimulator for managing chronic non-cancer pain in adults in 2020. The review highlighted clinical evidence that shows that a10kHz high-frequency spinal cord stimulator improves pain relief and quality of life for patients, with the added benefit of not producing paresthesia, a common side effect in traditional spinal cord stimulation. The report concludes that the 10kHz high-frequency spinal cord stimulator shows promise, but more high quality, long-term studies are needed to fully assess its safety, effectiveness, and cost-effectiveness. It recommends the 10kHz high-frequency spinal cord stimulator as a viable treatment for those who have not responded to conventional therapies, with careful patient selection and ongoing monitoring.
- A 2023 consensus guideline titled “Evidence-Based Consensus Guidelines on Patient Selection and Trial Stimulation for Spinal Cord Stimulation Therapy for Chronic Non-Cancer Pain” put out 39 recommendations. Some of these recommendations include that a spinal cord stimulator trial should be completed before a spinal cord stimulator implant, and all patients must be screened for psychosocial factors.
- A 2023 Cochrane review evaluated the effectiveness of spinal cord stimulators for managing chronic low back pain. The review included 13 studies with 699 participants. The authors found that data in this review do not support the use of spinal cord stimulators to manage low-back pain outside a clinical trial and that current evidence suggest spinal cord stimulators probably does not have lasting clinical benefits that would outweigh the costs and risks of the surgical intervention.
- Based on available evidence and guideline recommendations, the Drug and Therapeutics Advisory Committee recommends that the 10kHz high-frequency spinal cord stimulators be funded by the WSIB when very specific criteria are met (as defined earlier on this page). Given the need for follow-up, the Drug and Therapeutics Advisory Committee recommends that patients are evaluated and have long-term monitoring done in hospital settings.