It has been recognized that spinal cord stimulation in appropriately selected patients is more effective than pharmacological therapy and avoided the daily use of medication with associated compliance issues and development of tolerance and side-effects. However, spinal cord stimulation was initially very expensive with a significant workup preplacement, a requirement of two visits to the operating theatre with associated inpatient stay and significant complication rates. In addition to this, the most expensive component of the spinal cord stimulator, the implantable pulse generator (IPG) needed to be replaced every 3 to 5 years depending upon usage and this required a further visit to the operating theatre.
IPG replacement was usually performed in the day-care unit. Therefore, spinal cord stimulation was seen as extremely expensive and access to it was limited primarily by funding concerns. A significant expenditure both financially and in terms of the pain service time was required to employ the therapy for one patient. Other concerns expressed by funders related to lack of knowledge regarding how this system actually worked.
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