What is a Spinal Cord Stimulator?
A spinal cord stimulator is a system that uses implanted electrical leads and a battery powered implanted pulse generator to stimulate the back. A spinal cord stimulator is implanted in a surgical procedure that is not pre-authorized under the Non-Acute Pain Guidelines. Providers who want to perform this procedure must therefore request pre-authorization from the carrier before performing the procedure.
When is a Spinal Cord Stimulator Appropriate?
A spinal cord stimulator is prescribed for treatment of select patients with chronic back or neck radicular pain, specifically patents with failed neck or back surgery that have:
- Persistent severe and functionally disabling radicular pain.
- Been provided with conservative non-surgical treatments.
- Undergone surgical treatment that failed to relieve symptoms and improve function and further surgery has been considered but not approved this time
- Complex regional pain syndrome, phantom limb and spinal cord injury dysethesias
Are there any pre-requisites to getting a spinal cord stimulator?
The medical provider must provide the treating physician’s detailed history, physical exam and complete diagnostic workup. Further, all claimant must undergo a comprehensive psychological evaluation to ensure they are no significant behavioral factors that would predict poor response to a SCs.
The psychological evaluation must include a clinical interview and complete review of the records, a standardized detailed personality inventory and pain inventory. The psychological evaluation should demonstrate there are no primary risk factors or red flags and that the patient has a demonstrated history or motivation and adherence to prescribed treatments. Only if the claimant meets all pre-requisites may the claimant be eligible for pre-authorization for a spinal cord stimulator screening trial to determine how effective it might be.
The screening trial
During the trial, patient receives a temporary external device for three to seven days while completing normal daily activities. Upon completion of the trial, the results are evaluated to determine if the patient is a candidate for a permanent spinal cord stimulator implant. The patient is required to maintain a pain an activity diary during the screening trial.
A screening trial is considered successful if:
- Stimulation covers the patient’s pain areas
- Patient is comfortable with the feeling of stimulation.
- Patient experiences a 50% decrease in pain, which must be validated by either the Visual Analog Scale or numerical rating scale.
- Demonstrates objective functional gains or decreased use of pain meds
Only if the pre-screening is successful can the treating physician request pre-authorization from the carrier to implant a permanent spinal cord stimulator.
