• Lawrence Poree, Elliot Krames, Jason Pope, Timothy R Deer, Robert Levy, and Louise Schultz.
• Department of Anesthesiology, University of California San Francisco, San Francisco, CA, USA.
• Neuromodulation. 2013 Mar 1; 16 (2): 125-41.

BackgroundSpinal cord stimulation (SCS), by virtue of its historically described up-front costs and level of invasiveness, has been relegated by several complex regional pain syndrome (CRPS) treatment algorithms to a therapy of last resort. Newer information regarding safety, cost, and efficacy leads us to believe that SCS for the treatment of CRPS should be implemented earlier in a treatment algorithm using a more comprehensive approach.MethodsWe reviewed the literature on pain care algorithmic thinking and applied the safety, appropriateness, fiscal or cost neutrality, and efficacy (S.A.F.E.) principles to establish an appropriate position for SCS in an algorithm of pain care.Results And ConclusionBased on literature-contingent considerations of safety, efficacy, cost efficacy, and cost neutrality, we conclude that SCS should not be considered a therapy of last resort for CRPS but rather should be applied earlier (e.g., three months) as soon as more conservative therapies have failed.© 2013 International Neuromodulation Society.

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