The case for adopting Senza spinal cord stimulation (SCS) for delivering HF10 therapy as a treatment option for chronic neuropathic back or leg pain after failed back surgery is supported by the evidence. HF10 therapy using Senza SCS is at least as effective as low‑frequency SCS in reducing pain and functional disability, and avoids the experience of tingling sensations (paraesthesia).
Senza SCS for delivering HF10 therapy should be considered for patients:
with residual chronic neuropathic back or leg pain (at least 50 mm on a 0 mm to 100 mm visual analogue scale) at least 6 months after back surgery despite conventional medical management and
who have had a successful trial of stimulation as part of a wider assessment by a multidisciplinary team.
Patients with other causes of neuropathic pain were included in the evaluation and may be considered for HF10 therapy using Senza SCS but any additional benefits compared with low‑frequency SCS are less certain. Cost modelling indicates that, over 15 years, HF10 therapy using Senza SCS has similar costs to low‑frequency SCS using either a rechargeable or non-rechargeable device.
Clinicians implanting SCS devices including Senza should submit timely and complete data to the UK Neuromodulation Registry.
When assessing the severity of pain and the trial of stimulation, the multidisciplinary team should be aware of the need to ensure equality of access to treatment with SCS. Tests to assess pain and response to SCS should take into account a person's disabilities (such as physical or sensory disabilities), or linguistic or other communication difficulties, and may need to be adapted.
Why the committee made these recommendations
The use of SCS for chronic neuropathic pain is recommended in the NICE technology appraisal guidance on spinal cord stimulation for chronic pain of neuropathic for ischaemic origin. This medical technology guidance assessed the evidence to support the additional benefits of HF10 therapy using Senza compared with low‑frequency SCS in patients with chronic neuropathic pain.
Clinical trial evidence shows that HF10 therapy using Senza SCS is at least as effective as low‑frequency SCS in relieving pain for patients with chronic back or leg pain after failed back surgery. For other patients with chronic neuropathic pain, HF10 therapy using Senza SCS remains an option alongside other SCS options because there is more uncertainty about its additional benefits compared with low‑frequency SCS.