Spinal cord stimulation in the treatment of chronic pain: from evidence to clinical practice - part 2.

INTRODUCTION: Spinal cord stimulation (SCS) is a treatment option for patients with chronic pain who have not responded adequately to conventional therapies. Despite the use of this technique in clinical practice in Poland, specialists do not have guidelines specifying the place of SCS in the therapeutic algorithm. AIM OF THE STUDY: The primary objective is to propose a therapeutic pathway for patients with chronic pain, specifically incorporating SCS. The scope of the paper includes an eligibility assessment algorithm for SCS, procedural details, and post-implantation management. Furthermore, the assessment includes a cost-utility analysis and the estimated number of implantations for the 2025-2026 period. MATERIAL AND METHODS: The position statement reflects input from experts in neurosurgery, anesthesiology, and neurology, and is supplemented by a discussion of European guidelines on the use of SCS in patients with chronic pain. DISCUSSION: Spinal cord stimulator implantation is indicated when conventional treatments provided by a specialized pain clinic prove insufficient. The procedure requires a multidisciplinary team decision based on the patient's clinical history and may be preceded by a trial phase to assess efficacy. Post-implantation care involves monitoring, parameter adjustment, and continued management at a specialized pain clinic. In the population analyzed, SCS implantation was shown to be cost-effective. The number of SCS implantations is estimated at 458 and 524 in 2025 and 2026, respectively. CONCLUSIONS: This paper may serve as a starting point for further administrative work, including clarification of the scope and conditions for the provision of healthcare services.