Senza spinal cord stimulation system for delivering HF10 therapy to treat chronic neuropathic pain

3 Current practice

For low back pain and sciatica, the NICE guideline on low back pain and sciatica in over 16s recommends self-management, exercise, psychological therapy and pharmacological therapies. If these are not effective, the guideline recommends invasive treatments including surgery. It does not refer to spinal cord stimulation (SCS).

NICE technology appraisal guidance on spinal cord stimulation recommends SCS as a treatment option for chronic pain of neuropathic origin that continues for at least 6 months despite conventional medical management (including pharmacological treatment, physiotherapy and psychological support) in adults who have had a successful trial of stimulation as part of a wider assessment by a multidisciplinary team. If different SCS systems are considered to be equally suitable for a person, the least costly should be used. Assessment of cost should take into account acquisition costs, the anticipated longevity of the system, the stimulation needs of the person with chronic pain and the support package offered. SCS is not recommended for chronic pain of ischaemic origin, except in the context of research. A review of the guidance in 2013 concluded that more recent evidence (including evidence on Senza) would be unlikely to change the recommendations and the guidance was placed on the static list.

The British Pain Society publication Spinal cord stimulation for the management of pain: recommendations for best practice (2009) supports the use of SCS only after a multidisciplinary assessment by healthcare professionals experienced in using the technology.