How the Abbott SCS Implant Treats Chronic Pain

Abbott’s spinal cord stimulation (SCS) implants are surgically placed devices that deliver mild electrical pulses to the spinal cord to interrupt chronic pain signals before they reach the brain. The company’s flagship technology, called BurstDR, sets its systems apart from competitors by mimicking natural nerve-firing patterns rather than sending a steady stream of electrical pulses. Backed by randomized trial data showing that roughly seven in ten patients prefer it over conventional stimulation, Abbott’s SCS platform has become one of the most widely discussed options in neuromodulation, though the decision to get one involves weighing real complications, a meaningful device-removal rate, and the importance of psychological screening that many patients do not expect.

How Spinal Cord Stimulation Interrupts Pain

At its core, every SCS system works by placing thin electrical leads in the epidural space of the spine, near the dorsal columns, where sensory nerve fibers carry pain signals upward toward the brain. A small battery pack called an implantable pulse generator (IPG), typically placed under the skin of the buttock or abdomen, powers those leads. When the device is on, the electrical pulses change the way the spinal cord processes pain signals, essentially turning down the volume on them.

The traditional form of stimulation, called tonic SCS, works primarily at the spinal level by triggering inhibitory nerve cells in the dorsal horn to release a chemical called GABA. That burst of GABA damps down the overexcited pain-signaling neurons that drive chronic neuropathic pain.¹ Animal research has also shown that SCS calms wide-dynamic-range neurons in the dorsal horn while reducing excitatory chemicals like glutamate and aspartate.² Tonic SCS also activates a feedback loop involving descending nerve fibers from the brainstem that release serotonin, adding a second layer of pain suppression on top of the local spinal mechanism.³

This explains why SCS can help pain that medications cannot always reach. Rather than blocking a single receptor the way a drug does, the device reshapes the spinal cord’s processing environment at multiple points simultaneously.

What Makes Abbott’s BurstDR Different

Traditional tonic SCS sends a constant, evenly spaced series of electrical pulses. Patients feel this as a tingling or buzzing sensation called paresthesia. Some people find the tingling tolerable or even reassuring, but others find it annoying, and it can interfere with sleep. Abbott’s BurstDR waveform takes a fundamentally different approach by delivering clusters of pulses followed by quiet intervals, which more closely mirrors the way neurons naturally fire in bursts.

These burst-firing patterns engage different parts of the pain pathway than tonic stimulation does. Where tonic SCS acts primarily on the lateral pain pathway, which handles the sensory dimension of pain (where it hurts and how intense it is), burst stimulation also modulates the medial pathway, which processes the emotional and psychological suffering that comes with chronic pain.⁴ This dual-pathway engagement helps explain a consistent clinical finding: burst SCS improves not just pain scores but also mood and psychological well-being in ways that tonic stimulation does not always match.⁵

Intraoperative monitoring has revealed something else interesting about Abbott’s BurstDR specifically. Compared to burst waveforms from other manufacturers, BurstDR activates muscles at far lower electrical thresholds and shows a distinct pattern of exciting distal muscle groups before proximal ones. Researchers also observed a “priming” effect in which BurstDR stimulation produced stronger responses when switching back to tonic mode, suggesting it changes the excitability state of spinal cord neurons in a unique way.⁶ For patients, the practical upshot is that BurstDR provides pain relief without the constant paresthesia that comes with tonic stimulation, which is a major reason people prefer it.

The SUNBURST Trial and Pooled Evidence

The landmark clinical trial for Abbott’s burst technology is the SUNBURST study, a prospective, randomized controlled trial. The results showed that burst stimulation was not only noninferior to tonic stimulation but statistically superior to it. When given a choice, about 71% of participants preferred burst over tonic, and that preference held steady through one year of follow-up, with roughly 68% still choosing burst, about 24% preferring tonic, and 8% having no preference. The safety profile was comparable to other SCS studies, with no unanticipated adverse events.⁷

A systematic review that pooled real-world data across multiple studies found consistent results. Starting from a baseline pain rating of about 77 on a 100-point scale, tonic SCS brought scores down to around 49, while burst SCS reduced them further to roughly 37. That 12.5-point gap between the two waveforms represents a clinically meaningful difference. Across these studies, about 65% of patients preferred burst when given the option.⁸

Worth noting: the preference for burst grew stronger over time. The reasons patients cite most often are greater pain relief, the absence of paresthesia, and an overall impression that their condition has improved.⁹

How Burst Compares to High-Frequency Stimulation

Abbott’s BurstDR is not the only paresthesia-free waveform on the market. High-frequency stimulation at 10 kHz, offered by competitor Nevro, also delivers pain relief without the tingling sensation. A natural question for anyone considering an SCS implant is whether one waveform outperforms the other.

A prospective, randomized, single-blind crossover study directly compared 10 kHz high-frequency stimulation and burst SCS. Both therapies produced statistically significant pain relief, and neither showed a clear advantage over the other in head-to-head analysis. One notable finding was a “first-trialed” bias: whichever stimulation type a patient experienced first during their trial period was more likely to be the one they ultimately chose for permanent implantation.¹⁰ This trial-sequence effect complicates the story. It suggests that patient preference may be partly shaped by initial exposure rather than by an objective superiority of one waveform, which is something to keep in mind when your doctor presents options.

Conditions That Abbott SCS Treats

The most common reason people get an SCS implant is failed back surgery syndrome, where chronic back and leg pain persists after one or more spinal operations. But the list of conditions has expanded considerably in recent years.

Painful diabetic neuropathy is one of the newer frontiers. An international consensus statement concluded that for people with refractory diabetic nerve pain, SCS is an effective and durable treatment, and that opioids should not be used as a long-term solution in this population. High-frequency SCS in particular showed strong results for this condition, improving quality of life alongside pain relief.¹¹ Other research supports the view that SCS should be considered earlier in the course of diabetic neuropathy rather than as a last resort.¹²

Abbott also makes a device specifically for dorsal root ganglion (DRG) stimulation, called the Proclaim DRG system. The dorsal root ganglion is a cluster of nerve cell bodies just outside the spinal cord, and targeting it directly offers advantages for pain that is localized to a specific area, like the foot or groin, where traditional SCS sometimes struggles. In complex regional pain syndrome (CRPS), for instance, DRG stimulation appears to work by calming overexcitable nerve cells at the ganglion, restoring their ability to filter electrical signals, and suppressing the inflammatory responses that amplify pain.¹³

The Proclaim XR Device

Abbott’s Proclaim XR system is a primary-cell (non-rechargeable) neurostimulator designed to deliver BurstDR therapy. Its key selling point for patients is that it does not require regular recharging sessions, which can be a significant burden with rechargeable devices. The system uses a low-amplitude, intermittent dosing approach to conserve energy, and Abbott guarantees a battery life of five to ten years.¹⁴ When the battery runs out, the IPG is replaced in a relatively minor outpatient procedure, leaving the existing leads in place.

For some people, skipping the recharging hassle is the deciding factor. Rechargeable systems from Abbott and competitors can last longer before replacement, but they require patients to sit with a charging coil for anywhere from 30 minutes to a couple of hours at regular intervals. People with limited mobility, cognitive challenges, or who simply do not want another daily health task often gravitate toward recharge-free options.

Remote Programming and Digital Health

One of the more practical innovations in Abbott’s SCS ecosystem is the NeuroSphere Virtual Clinic, a teleprogramming platform that allows clinicians to adjust stimulation settings remotely through a real-time audio-video link. Pilot data showed that both patients and clinicians preferred this approach, and it caused minimal disruption to patients’ daily routines.¹⁵

This matters more than it might sound. After implantation, SCS devices usually need several adjustment sessions to optimize the settings for each person’s anatomy and pain patterns. Traditionally, every one of those sessions meant a trip to the clinic, which could mean driving hours each way for patients in rural areas. Remote programming collapses those visits into video calls where the clinician can make changes to the device in real time while the patient describes what they feel.¹⁶ For people managing chronic pain, eliminating travel is not a luxury; a bad pain day in a car can set recovery back.

Complications and What to Expect

SCS implantation is not a low-risk procedure. Review data put the overall complication rate at roughly 30% to 40% of patients experiencing at least one adverse event of some kind, though the vast majority are manageable rather than catastrophic.¹⁷ The most common problem is lead migration, where the thin electrode shifts out of position and changes the coverage pattern of stimulation. When that happens, you might notice that the pain relief weakens or covers a different area than before. Other hardware issues include lead fracture and IPG malfunction.

On the biological side, infection occurs in about 2.5% of cases. A multicenter retrospective study found that diabetes, tobacco use, and obesity did not independently raise infection risk, which surprised many clinicians. Patients who received occlusive dressings or postoperative antibiotics had lower infection rates.¹⁸ Hematomas, including the more serious spinal epidural variety, have a pooled incidence of under 1%.¹⁹ Serious neurological injury from SCS is rare, but dural puncture headaches and discomfort over the implant site are reported with some regularity.

When Devices Get Removed

Not every SCS implant stays in permanently. A systematic review covering over 13,000 patients who received permanent SCS implants between 1984 and 2024 found that about 10% ultimately had their device removed. The most common reason was inadequate pain relief, accounting for roughly 38% of removals, followed by lead failure at 15% and infection at 14%.²⁰ A separate survey of SCS patients found an even higher proportion citing loss of effectiveness as their reason for explantation, at about 54%.²¹

An international retrospective chart review broke down explantation rates by device type and found that the rate of removal for inadequate pain relief ranged from about 7% with conventional nonrechargeable devices to about 14% with high-frequency rechargeable systems.²² These numbers serve as an honest reality check. SCS works well for many people, but a meaningful minority do not get lasting benefit, and having the device removed is a real possibility that should be part of the conversation before implantation.

Why Psychological Screening Matters

One aspect of the SCS process that catches many patients off guard is the psychological evaluation. Before you can get a permanent implant, most programs require a screening by a psychologist or psychiatrist. This is not a formality.

Research consistently shows that certain psychological factors predict poorer outcomes with SCS. Pain catastrophizing, the tendency to ruminate on pain, magnify its threat, and feel helpless about it, is associated with worse results after implantation.²³ A scoping review that informed a proposed screening algorithm found that catastrophizing and an external locus of control (the belief that your pain is entirely outside your ability to influence) were both linked to negative outcomes.²⁴

This does not mean that people with depression or anxiety are automatically disqualified. The screening is meant to identify modifiable risk factors that can be addressed before implantation. If catastrophizing is your primary red flag, cognitive behavioral therapy before the procedure may improve your chances. The screening also helps set realistic expectations, which is important because SCS typically reduces pain rather than eliminating it entirely.

Opioid Reduction After Implantation

For many patients and the clinicians who treat them, one of the most compelling arguments for SCS is its potential to reduce or eliminate opioid use. A secondary analysis of the Evoke randomized trial found that at 24 months, about two-thirds of patients who were taking opioids at baseline had voluntarily reduced or eliminated their use. Average daily opioid doses dropped from about 80 morphine milligram equivalents to around 42 in the closed-loop group, bringing patients under the 50 morphine milligram equivalent threshold that current practice guidelines recommend. Alongside the opioid reduction, patients showed improvements in mood, disability scores, sleep quality, and general quality of life.²⁵

The consensus statement on SCS for diabetic neuropathy was blunt about the alternative: for people with refractory pain, opioids are a high-risk option that do not provide a long-term solution and should not be used.²⁶ SCS does not eliminate the need for medication in everyone, but for people who have been stuck on escalating opioid doses with diminishing returns, the combination of pain relief and opioid reduction represents a meaningful change in trajectory.

Cost-Effectiveness and the Break-Even Point

SCS implants are expensive upfront. The device, leads, surgical placement, and the trial period that precedes permanent implantation can collectively cost tens of thousands of dollars. Unsurprisingly, this prompts the question of whether the investment pays off over time compared to ongoing conventional medical management (medication, injections, physical therapy, emergency visits).

An analysis using data from the DISTINCT randomized trial found that SCS patients used fewer healthcare resources and incurred lower overall costs than patients managed conventionally. Including the cost of the device itself, the break-even point was reached in about 2.7 years.²⁷ By 18 months, the clinical benefits of SCS in the DISTINCT cohort remained stable, accompanied by reduced healthcare utilization and about $1,214 in cost savings over conventional management.²⁸

These figures come from a U.S. commercial payer perspective and will look different depending on insurance coverage and healthcare system. But the general pattern holds across multiple analyses: SCS costs more at the start and saves money over the following years through fewer medications, fewer injections, fewer emergency department visits, and fewer follow-up procedures. For someone weighing the decision, the relevant question is often not whether SCS is cost-effective in the abstract, but whether you are likely to be among the roughly 60% to 70% of patients who get sustained relief. That is where thorough screening, including the psychological evaluation, earns its value.