Updated March 20, 2026

A spinal cord stimulator is an implanted device that sends low levels of electricity directly into the spinal cord to relieve pain. This guide was developed by Eellan Sivanesan, M.D., associate professor and director of neuromodulation at Johns Hopkins, whose clinical and research work focuses on advanced spinal cord stimulation and mechanism-based pain therapies.

What is a spinal cord stimulator, and how does it work?

Spinal cord stimulators consist of thin wires (the electrodes or leads) and a small, pacemaker-like battery pack (the generator). The electrodes are placed in an area around the spinal cord (the epidural space), and the generator is placed under the skin, usually near the upper buttocks or flank. A spinal cord stimulator allows the person to send electrical impulses using a remote control when they feel pain. Both the remote control and its antenna are outside the body.

Although the exact mechanisms of spinal cord stimulation are still being studied, current research shows that it changes how pain signals travel through the different parts of the nervous system, including the spinal cord and the brain. Spinal cord stimulation affects how the body processes sensations and chemical signals involved in how we feel pain.

Traditional spinal cord stimulation often creates a tingling sensation, known as paresthesia, which overlaps with painful areas and can lower how strong the pain feels. Newer stimulation modes, such as high-frequency and burst stimulation, may relieve pain without creating noticeable sensations. These are often called “sub-perception” therapies.

Contemporary spinal cord stimulation systems are implanted by physicians with specialized training in interventional pain medicine, typically using fluoroscopic (X-ray) guidance to ensure accurate epidural lead placement.

What is spinal cord stimulation used for?

Spinal cord stimulation is most often considered for people with chronic pain who have not achieved adequate relief with conservative treatments, medication or surgery. It is mainly used for nerve-related and mixed pain conditions, and may be appropriate for certain patients after careful evaluation by a multispecialty team. Reasons for using spinal cord stimulation include but are not limited to the following:

• Back pain, especially back pain that continues even after surgery (failed back surgery syndrome)
• Postsurgical pain
• Arachnoiditis (painful inflammation of the arachnoid, a thin membrane that covers the brain and spinal cord)
• Heart pain (angina) untreatable by other means 
• Spinal cord injury
• Nerve-related pain (such as severe diabetic neuropathy and cancer-related neuropathy from radiation, surgery or chemotherapy)
• Peripheral vascular disease
• Complex regional pain syndrome
• Pain after an amputation 
• Visceral abdominal pain and perineal pain

For some people, spinal cord stimulation may improve pain control, daily functioning, sleep and overall quality of life, and it may reduce the need for pain medications. It is usually used as part of a comprehensive pain management plan that includes medical, physical and behavioral therapies, with ongoing check-ins and tailored adjustments.

Who should get a spinal cord stimulator?

As with all medical treatments, careful evaluation is important to determine whether spinal cord stimulation is appropriate and likely to provide meaningful benefit. Before recommending this therapy, a pain specialist typically reviews past treatments, obtains relevant imaging and performs a comprehensive assessment that may include psychological screening. Most insurance providers require psychological screening as part of the approval process to help identify factors that may affect how well the treatment works and what long-term results to expect.

Although each person’s situation is unique, spinal cord stimulation tends to be most beneficial for people who:

• Have not experienced sufficient pain relief with medications, less-invasive therapies or surgeries
• Do not have untreated psychiatric disorders that would decrease the effectiveness of the procedure

What are the different types of spinal cord stimulators?

Spinal cord stimulation systems are usually classified based on their power source and method of energy delivery. The main types include:

1. Nonrechargeable implantable pulse generators (IPGs) are battery-powered devices implanted under the skin, typically in the buttock, flank or the abdomen. When the battery is depleted, the device needs to be surgically replaced. These systems may be appropriate for people who need lower energy output.
2. Rechargeable implantable pulse generators work similarly to nonrechargeable IPGs, but allow the battery to be recharged externally, reducing the need to surgically replace the device. Rechargeable systems support a wide range of stimulation modes, and are often used in people who need higher energy output or more complex programming.
3. Radiofrequency (RF) systems use an externally worn power source that transmits energy to an implanted receiver. These systems are rarely used due to advances in fully implantable rechargeable devices.

Your physician will provide instructions on operating the system and adjusting stimulation settings. Modern devices offer tailored settings for different activities and body positions. Many systems support multiple stimulation modes, including conventional tonic stimulation, high-frequency, burst and high-density waveforms, and can store several customized programs.

Spinal Cord Stimulator Surgery

Spinal cord stimulators require two procedures to test and implant the device: the trial and the implantation.

Spinal Cord Stimulator Trial

The first step in spinal cord stimulation is a trial period to assess whether the therapy provides meaningful pain relief. During this procedure, the physician places temporary stimulation leads into the epidural space using real-time X-ray guidance (fluoroscopy). The location of the pain helps determine the level of the spine where the leads are positioned. In some cases, patient feedback during the procedure is used to help place the leads.

The trial procedure typically requires a small incision in the lower back to introduce the leads. The stimulation leads are connected to an external pulse generator that remains outside the body and is usually worn on a belt or secured to clothing.

Over several days, patients evaluate how well the stimulation reduces pain and improves function. A trial is generally considered successful if there is meaningful improvement in pain and/or function, often defined as about 50% or greater pain reduction, though personal goals may vary.

If the trial is unsuccessful, the temporary leads are removed in the clinic, usually with minimal discomfort and very low risk of complications. If the trial is successful, a separate procedure is scheduled to implant a permanent spinal cord stimulation system.

Spinal Cord Stimulator Implantation

During the permanent implantation procedure, the pulse generator is placed under the skin, and the temporary trial leads are replaced with permanent, sterile stimulation leads. These permanent leads are secured using anchoring techniques designed to minimize movement over time.

The implantation procedure usually takes about two hours, and patients can go home the same day. The procedure may vary slightly depending on which stimulation system is used, but typically includes the following steps:

• The patient receives local anesthesia with light sedation. Additional sedation can be used if needed.
• The physician makes one incision to create a pocket for the generator, usually in the buttock, flank or lower abdomen.
• A second incision is made near the spine to place the permanent leads into the epidural space (the area around the spinal cord).
• Each incision is usually a few centimeters long. Fluoroscopy is used throughout the procedure to guide accurate lead placement. In some cases, the physician may ask for the patient’s feedback during lead positioning to ensure optimal lead placement.
• Once the leads and generator are connected and functioning properly, the incisions are closed.

Spinal Cord Stimulator Recovery

Most patients go home the same day as their procedure, once the effects of anesthesia and sedation wear off. Mild to moderate discomfort at the incision sites is common during the first several days after surgery. During this time, patients should avoid excessive bending, twisting, lifting or reaching, which could put stress on the incisions and implanted leads.

Dressings are typically placed over the incision sites and are removed after several days or when the care team recommends. In most cases, the incisions heal within two to four weeks.

Patients receive a personalized recovery plan. Light activity is generally recommended for the first one to two weeks after surgery, with gradual return to normal activity.

Once cleared by the treating physician, patients may resume driving and return to work, usually within one to two weeks, depending on the rate of recovery and job demands. Patients are advised not to drive while adjusting stimulation settings.

Spinal Cord Stimulator Complications

Complications associated with spinal cord stimulation are uncommon, but as with any medical procedure, some risks exist. A small percentage of patients may experience:

• Infection (most likely in the first few weeks after implantation)
• Bleeding or hematoma formation at the surgical site
• Lead migration, when the stimulator leads shift from their original position, which can reduce stimulation effectiveness and may need a surgical correction.
• Device malfunction or damage, which may occur after trauma or intense physical activity
• Dural puncture, which can result in leakage of cerebrospinal fluid and cause headaches that are usually temporary and treatable
• Nerve injury, which is extremely rare but may result in neurological symptoms

Most complications can be managed effectively with prompt medical attention. Careful surgical technique, appropriate patient selection and close follow-up help minimize these risks.

Living with a Spinal Cord Stimulator

For many patients, spinal cord stimulation provides meaningful pain relief that allows greater participation in daily activities and improved quality of life. However, living with an implanted device also means paying attention to device management, following activity guidelines and keeping up with routine follow-up care.

Can I have X-rays and CT scans with a spinal cord stimulator?

In general, X-rays and CT scans can be performed safely in people with spinal cord stimulators. These imaging studies typically do not interfere with the device. Be sure to tell your doctor, nurse or imaging technician that you have an implanted stimulator before undergoing any type of scan.

Are spinal cord stimulators MRI compatible?

Not all spinal cord stimulators are compatible with MRI. Many newer systems are labeled MRI-conditional, meaning that MRI scans may be performed safely under specific conditions defined by the manufacturer. These conditions may include restrictions on the body region being scanned, the strength of the MRI magnet and device programming settings.

Older systems or certain lead configurations may not be MRI compatible. In these cases, MRI may pose risks such as heating of the leads, unintended stimulation or device malfunction.

Before scheduling an MRI, contact your specialist or neuromodulation team to confirm device compatibility and ensure that appropriate safety protocols are followed.

Will my spinal cord stimulator set off airport security scanners?

Implanted spinal cord stimulators may be detected by airport security screening systems. When people get a spinal cord stimulator, they usually also receive a device identification card from their care team. The card can be shown to security personnel during screening.

Some security systems, including metal detectors and body scanners, sometimes cause temporary or uncomfortable sensations in people with spinal cord stimulators. Although this is usually harmless, it may be best to avoid prolonged exposure and follow device manufacturer’s guidance.

If screening cannot be avoided, your physician or device manufacturer may recommend placing the stimulator in a low-power or off mode before passing through security.

Can I drive with a spinal cord stimulator?

Most people can drive safely with a spinal cord stimulator once they have recovered from surgery and are used to their stimulation settings. However, avoid adjusting stimulation levels or programs while driving, as sudden changes in sensation could be distracting.

It may be best to turn off the device while driving if you are:

• Adjusting the programming
• Trying new settings
• Experiencing unexpected stimulation effects

Always follow specific recommendations provided by your treating physician and device manufacturer.

Can I swim with a spinal cord stimulator?

Swimming and bathing are generally allowed once a permanent spinal cord stimulator has been implanted and the incision sites have fully healed. However, wait until your physician confirms that wound healing is complete before submerging the device.

During the stimulator trial period, the temporary leads and external generator must be kept dry. This means avoiding swimming, bathing or showering unless specifically instructed on how to protect the equipment from moisture.

Your treating physician will guide you on when it is safe to resume water activities.

Can a spinal cord stimulator be removed?

Yes, a spinal cord stimulator can be removed if medically necessary, such as due to an infection or a serious device-related complication.

Before considering removal, work with your care team to optimize device settings and address concerns. Many issues can be successfully managed without additional surgery. For example, changes in programming, waveform selection, lead positioning or supportive therapies can significantly improve pain relief and patient satisfaction.

Under the care of experienced neuromodulation specialists, most people can achieve lasting benefit through personalized programming and long-term follow-up.

Device removal is typically considered only after all reasonable nonsurgical options have been carefully explored. Learn more about spinal cord stimulator removal.

Medically reviewed by Eellan Sivanesan, M.D.