Health Care Providers’ Opinions on Decision-Making During the Spinal Cord Stimulation Journey: An Online Survey

Introduction The field of spinal cord stimulation (SCS) is characterized by the availability of multiple stimulation paradigms and device options, yet limited evidence exists on ways health care providers make decisions during clinical reasoning. This study aimed to explore health care providers’ opinions and reasoning during the decision-making process in SCS therapy, focusing on factors influencing the choice of stimulation paradigm and manufacturer. Materials and Methods An online survey was distributed among health care professionals involved in neuromodulation for pain through the North American Neuromodulation Society newsletter and during the 2nd Pain Academy in Madrid (2024). Health care professionals were asked to indicate the reasoning behind the decision-making on which type of SCS will be implanted, and from which manufacturer devices will be implanted. Results A total of 102 respondents completed the survey, of whom 90 were clinical practitioners or nurses and included in the analysis. The first major decision typically concerned the selection of the stimulation paradigm (39.8%), primarily influenced by patient pathology and characteristics. The choice of manufacturer was primarily determined by the level of technical support and service. Paresthesia-based SCS remained widely used (64.6%), yet paresthesia-free stimulation was more often used (86.6%). Magnetic resonance imaging (MRI) conditionality and other extraparadigm features also were identified as relevant determinants in device selection. Discussion Decision-making in SCS shows substantial variability among health care providers. Although implanters generally hold final responsibility, factors such as patient characteristics, manufacturer support, and MRI conditionality play a major role in guiding clinical choices. These findings underscore the need for clearer decision frameworks, transparent reasoning, and greater multidisciplinary involvement in SCS therapy selection.