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Is Pocket Pain Still a Major Issue in Spinal Cord Stimulation?
Matthew W Scarsbrook1, Anneleigh Belle Twer1, Gage Tedford1
1Department of Neurosurgery, University of Arizona College of Medicine, Tucson, AZ, USA.
Introduction:
Pocket pain is a recognized reason for dissatisfaction or revision after spinal cord stimulation (SCS). Historically, patients with pocket pain require revision or explantation. With the advent of smaller implantable pulse generators (IPGs), we investigated whether incidence of pocket pain and resultant revision has decreased.
Objectives:
This study aimed to assess whether pocket pain incidence has decreased over time and correlate confounding variables.
Materials And Methods:
We examined all patients who underwent placement of an SCS implant from January 2017 to June 2025. The patients were observed longitudinally through their last clinical encounter. Demographic and implant characteristics were documented. The presence of pocket pain was manually parsed from assessment of clinical notes. Associations between development of pocket pain and generator thickness, battery volume, pocket location, sex, body mass index, and year of implantation were evaluated.
Results:
Among 250 patients who underwent initial permanent SCS implantation, pocket pain developed in 16 (6.4%), and ten (4.0%) required revision or explantation. Pocket pain incidence decreased over time, with each calendar year associated with a 31% reduction in odds (odds ratio 0.69 per year, 95% CI 0.52-0.86, p < 0.001). Mean IPG thickness decreased during the study (β = -0.34 mm/y, p < 0.001). Battery volume also decreased over time (-0.58 cc/y, p = 0.002), but volume was not independently associated with pocket pain or revision. Patients with pocket pain had thicker generators (11.6 ± 1.4 mm vs 10.5 ± 2.4 mm, p = 0.006) and were more likely to have buttock placement (63% vs 35%, p = 0.034). After adjustment for IPG thickness and pocket location, calendar year was no longer independently associated with pocket pain. Pocket pain incidence was 2.76% from 2021 to 2025.
Conclusion:
The incidence of clinically relevant IPG pocket pain after SCS has decreased over time owing to the adoption of thinner generators and evolving implantation strategies.
