[German guideline on spinal cord stimulation for chronic neuropathic pain]

Epidural spinal cord stimulation (SCS) is a neuromodulatory, reversible procedure for the treatment of selected chronic pain conditions, primarily neuropathic in nature. The updated German S3 guideline provides evidence-based recommendations for the use of SCS and dorsal root ganglion stimulation (DRG-S). Key innovations include recent technical advances and increased integration into multimodal pain management. The guideline aims to enhance the care of patients with chronic pain by offering rational, scientifically substantiated recommendations. A systematic literature review was conducted, including meta-analyses and randomized controlled trials, with relevant case reports also taken into account. Publications were evaluated by topic, including fundamentals, indications, methods, complications, quality management, and psychosocial aspects. Recommendations are based on established evidence classifications. Major updates include strong evidence in favor of SCS for diabetic polyneuropathy. For other neuropathies, smaller studies indicate positive effects. SCS is considered the most effective therapy for chronic, postoperative back and leg pain. Additionally, SCS receives a strong recommendation for peripheral arterial occlusive disease (Fontaine stages IIb and III). For complex regional pain syndrome (CRPS), DRG‑S demonstrates superiority over SCS and is preferentially recommended. The guideline addresses all professional groups involved in the care of pain patients and offers practical guidance for therapeutic decision-making in the management of chronic pain.