Spinal cord stimulation, by a named neuromodulation consultant.

NHS SCS is commissioned under NICE TA159 in England through specialist neuromodulation centres, with long waits. Private packages cover the consultation, trial, permanent implant, hardware, hospital stay and programming visits.

• Failed back surgery syndrome (FBSS)

  Persistent neuropathic leg pain after one or more lumbar operations, with radicular distribution and MRI showing epidural fibrosis rather than a fresh compressive lesion.

• Complex regional pain syndrome (CRPS)

  Type I or II CRPS of a limb with allodynia, autonomic and trophic changes. DRG stimulation often outperforms conventional SCS for focal foot, hand or knee distributions.

• Painful diabetic neuropathy (PDN)

  Symmetrical lower-limb burning neuropathic pain despite optimised glycaemic control and first-line pharmacotherapy. HF10 kHz has the strongest evidence in this group.

• Neuropathic pain after peripheral nerve injury

  Post-traumatic or post-surgical mononeuropathy: ilioinguinal, genitofemoral, intercostal, brachial plexus injury with well-mapped neuropathic distribution.

• Post-herpetic neuralgia

  Selected patients with truncal or limb post-herpetic pain unresponsive to gabapentinoids, tricyclics, topical lidocaine and interventional blocks.

• Refractory angina

  Chronic refractory angina despite maximal medical therapy and revascularisation options exhausted. High-cervical leads for cardiac coverage.

• Ischaemic limb pain

  Non-reconstructable peripheral vascular disease with rest pain, in selected patients where amputation is being considered.

• Red flag: untreated psychological comorbidity

  Active untreated depression, somatisation or unrealistic expectations predict a poor SCS outcome. Screening and preparation come first, not the implant.

• Sedation and anaesthesia

  Trial leads are placed awake under local anaesthesia and X-ray to confirm paraesthesia coverage. Permanent implant is done under conscious sedation or light general anaesthetic.

• Lead migration

  The commonest hardware problem, in 3 to 10% of cases at 5 years. Programming can compensate for small shifts; larger migrations need a revision procedure.

• Infection

  Pocket or lead infection in about 2 to 5% of implants. Managed with antibiotics and, in most cases, removal of the system followed by re-implant after a clear interval.

• Dural puncture and headache

  Uncommon at the trial stage. Managed conservatively, with an epidural blood patch reserved for persistent postural headache.

• Loss of efficacy over time

  A minority of patients lose benefit over months to years. Reprogramming, waveform switching or DRG conversion recovers response in many cases.

• MRI compatibility

  All current systems are MRI-conditional under specific field strengths and body regions. We document the exact conditions and hand you a manufacturer card.

• IPG revision and replacement

  Primary cell batteries last 5 to 10 years at typical settings; rechargeable IPGs last around 10 years before elective replacement under local anaesthetic.

• Explant

  Around 10 to 15% of systems are eventually removed for loss of efficacy, infection or patient preference. Explant is a straightforward day-case procedure.

• Red flags after implant

  Fever, spreading redness, wound discharge, new weakness or loss of bladder or bowel control need urgent contact with the implanting team or A&E the same day.