Dual electrode spinal cord stimulation in chronic leg and back pain

Patients with chronic back and leg pain (CBLP) suffer from a disabling spinal condition of multifactorial origin and are often resistant to medical therapy. Spinal cord stimulation (SCS) is a minimally invasive option for treatment of chronic pain in these patients, which involves placement of epidural electrodes close to the midline of the spinal cord. SCS was originally introduced and used for decades with a single electrode. The development of fully implantable dual channel pulse generators connected to dual multicontact electrodes has given pain clinicians a more versatile tool to treat axial low back pain accompanied by radicular neuropathic pain with irregular and asymmetric distribution, a feature which is found in most CBLP patients. It has been hypothesized that using dual electrodes may improve long term outcome for CBLP patients compared with single electrodes. Current evidence however does not lend strong support to this assumption. Given the high cost of treatments for CBLP and of SCS itself, there is an urgent need for high-quality evidence for the effectiveness of dual electrode SCS in relieving pain and/or improving function in patients with CBLP.