Clinical Outcomes and Long-term Management of Spinal Cord Stimulation in Chronic Pain: 24-month Observational Study

Introduction: Spinal Cord Stimulation (SCS) has become a pivotal method in the treatment of varied conditions such as chronic pain.This study presents the 24-month outcomes of 252 patients treated with FAST-SCS .

Methods: A total of 270 patients with chronic lower back and leg pain were included. The Visual Analog Scale (VAS) sporsever were evaluated before the permanent implantation and 15 minutes after the electrode placement. Five patients who showed no decrease in VAS scores were excluded. Two patients were excluded due to electrode placement in the subdural space, nine due to infection, and two due to titanium allergy.
Following paresthesia optimization, the perception threshold was reduced by approximately 70% in order to activate FAST treatment. The FAST program was used in patients with reductions in VAS scores (pulse width: 280–320 µs, frequency: 90 Hz) intra-operatively. VAS scores were recorded at the 5 and 15 minutes, 24 hours, and at 3, 6, 9, 12, 15, 18, 21, and 24 months. The number of prior surgical interventions,use of analgesics and preoperative pain duration of patients’ were documented.

Results: It is noteworthy that the mean VAS scores of 9.13 in the first 24 hours decreased dramatically to 1.36 and remained stable with minor variations over 24 months.
Pain duration was examined in two subgroups: 7 years or less and more than 7 years. Despite the similar baseline VAS scores in both groups, patients with pain durations exceeding 7 years had higher VAS scores throughout all follow-up periods. In this group, VAS Scores did not decrease until the 9th month, but a rapid decline was observed thereafter.
The improvement in pain severity supports literature on emerging SCS modalities. Our study differs from Metzger et al. (2025) in certain aspects. While Metzger et al. used 32-contact, narrow-spaced electrodes, we utilized 16-contact, wide-spaced electrodes. Additionally, while they reduced the perception threshold by 30–40%, this study reduced the treshold by up to 70%. Despite these differences, reductions in VAS scores were similiar in both studies.

Furthermore, the present study observed a reduction in analgesic use following SCS implantation.

Conclusion: This retrospective study demonstrated that with the FAST system, rapid analgesia is provided with SCS, and pain-relieving effect persisting up to 2 years. Patients with shorter pain durations had faster reductions in VAS scores, and less medication dependence post-implantation.