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Spinal Cord Stimulation Service

Checked: 18-08-2023 by Rob Adams Next Review: 17-08-2025

Overview

Spinal cord stimulation (SCS) is a treatment for chronic pain that is usually considered after standard treatments have failed. SCS modifies the perception of neuropathic and ischaemic pain by stimulating the dorsal column of the spinal cord. SCS is minimally invasive and reversible. (1)

The Spinal Cord Stimulation Service at NBT offers patients a service for patients who meet referral criteria. This service is funded centrally by NHS England and so no funding approval is needed as long as the referral criteria are met.

Suitable patients include:

Painful Diabetic Neuropathy of the lower limbs, as per NICE guidelines TA159 (1) where referral criteria are met.
Chronic Neuropathic Pain of the trunk +/- limbs, as per NICE guidelines TA159 )1) where referral criteria are met.

Pain Visual Analogue Scale (VAS)

A VAS is a scale used to rate the patient's perception of the severity of their pain. In the referral criteria below the VAS suggested uses a scale between 0 to 10 where 0 is no pain and 10 is the most extreme pain they could ever imagine (also known as a Numeric Pain Rating Scale)

A score of 5 or above is needed for a referral as detailed in the pathways below.

Numeric Pain Rating Scale - Physiopedia (physio-pedia.com)

Diabetic Neuropathy

Please see the Neuropathic Pain (Remedy BNSSG ICB) page for management of diabetic neuropathy.

To qualify for SCS the patient should have a diagnosis of painful diabetic neuropathy of the lower limbs and experienced symptoms for at least 3 months with a Pain Visual Anologue Scale (VAS) score of 5 or more (2), and no other exclusions as outlined in the referral guidelines.

Chronic Neuropathic Pain

To qualify for SCS the patient should have a diagnosis of chronic neuropathic pain of the lower limbs or trunk and experienced symptoms for at least 3 months with a Pain Visual Anologue Scale (VAS) score of 5 or more (2), and no exclusions as outlined in the referral guidelines.

Referral

As this is a clearly defined pathway, the pain CBA policy will not apply in these patients as long as the more specific criteria in the pathway are met. If these criteria are not met, then the Pain CBA Policy would apply.

For referral queries please contact:

The NBT SCS Service at Gloucester House, Southmead Hospital, Bristol, BS10 5NB
Email: painclinicteam@nbt.nhs.uk
Telephone: 0117 414 7379

All patients will be screened for suitability and discussed within pain/neurosurgery MDT before proceeding with SCS.

Resources

(1) Guidance | Spinal cord stimulation for chronic pain of neuropathic or ischaemic origin | Guidance | NICE (TAG 159)

(2) Pain scales in multiple languages | British Pain Society

(3) SCS e-Health Tool - this tool requires an account and a log in but this can be set up from primary care.

(4) Visual Analogue Scale

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.