Which Spinal Cord Stimulator (SCS) is Best For Me?

John K. Hong, M.D. | 7/31/2025

Solving the SCS Puzzle: Which SCS works best?

Spinal cord stimulation (SCS) has revolutionized the treatment of chronic neuropathic pain, offering targeted relief for patients with conditions such as failed back surgery syndrome, complex regional pain syndrome, and radiculopathy. Among the leading manufacturers, Medtronic, Abbott, Boston Scientific, and Nevro offer state-of-the-art technologies with unique features and clinical applications.

In this blog, we compare their core technologies, programming capabilities, clinical outcomes, and patient considerations to help guide optimal device selection.

Side-by-Side Comparison

Feature	Medtronic Intellis™	Abbott Proclaim™ XR / Eterna™	Boston Scientific WaveWriter Alpha™	Nevro HFX™ (Omnia/10 kHz SCS)
Stimulation Type	Traditional & Adaptive Closed-Loop (ECAP)	BurstDR™, Tonic, Whisper upgrade	Tonic, Burst, Microdosing, FAST™ therapy	High-frequency 10 kHz + Low-frequency SCS
Closed-Loop Capability	Yes (ECAP-based)*	No	Yes (FAST™ with ECAP feedback)	No (Pre-programmed waveforms only)
Battery Life	~9 years (non-rechargeable) / Rechargeable	Up to 10 years (non-rechargeable)	~10–12 years (non-rechargeable)	~5–10 years (rechargeable only)
MRI Compatibility	Full-body conditional MRI	Full-body MRI compatible	Full-body MRI conditional	Full-body MRI conditional
Unique Features	AdaptiveStim™ adjusts based on position	BurstDR™ backed by large RCT (SUNBURST)	FAST™ relief within minutes, ECAP closed-loop	10 kHz stimulation avoids paresthesia
Recharge-Free Options	Yes (Intellis X)	Yes (Proclaim XR)	Yes (WaveWriter Alpha Prime)	No (All rechargeable)
Paresthesia-Free Options	Yes (with ECAP + sub-perception programs)	Yes (BurstDR)	Yes (FAST + Burst)	Yes (All 10 kHz therapy)

*ECAP = Evoked Compound Action Potential – real-time feedback from spinal cord to adjust stimulation.

Technology Breakdown

1. Medtronic (Intellis™ / Vanta™ / DTM SCS™)

• Technology: Offers traditional and closed-loop stimulation using ECAPs, with optional DTM (Differential Target Multiplexed) therapy, designed to modulate both neurons and glial cells.

• Strengths:

  • Strong battery life and adaptive programming.

  • Real-time neural feedback with ECAPs.

  • Good option for patients who benefit from precise positional adjustments.

• Best For: Patients with dynamic pain (e.g., pain changes with posture) or those needing MRI access. Also ideal for patients wanting a proven legacy device from a longstanding manufacturer.

2. Abbott (Proclaim XR™, Eterna™)

• Technology: BurstDR™ stimulation, which mimics natural neuronal firing patterns, is backed by randomized controlled trials (SUNBURST). Whisper™ upgrade enables expanded waveform access.

• Strengths:

  • Recharge-free systems with long battery life.

  • Highly effective BurstDR therapy for emotional and sensory pain.

  • App-based programming with Apple devices.

• Best For: Patients with high sensitivity to paresthesia or those preferring a low-maintenance, non-rechargeable system with evidence-backed efficacy for both neuropathic and nociplastic pain types.

3. Boston Scientific (WaveWriter Alpha™)

• Technology: Offers a versatile platform combining multiple waveforms including tonic, burst, microdosing, and the novel FAST™ therapy with rapid-onset pain relief and ECAP closed-loop feedback.

• Strengths:

  • Fast relief reported in <10 minutes with FAST therapy.

  • Flexibility in waveform programming.

  • Closed-loop ECAP technology integrated.

• Best For: Patients who have failed prior SCS or need high-level customization. Also suitable for those seeking rapid pain relief and real-time modulation.

4. Nevro (HFX™ with 10 kHz SCS)

• Technology: High-frequency 10,000 Hz stimulation designed to provide paresthesia-free pain relief, with data supporting use in back and leg pain as well as painful diabetic neuropathy.

• Strengths:

  • No paresthesia at all.

  • FDA approval for PDN and non-surgical back pain.

  • Unique clinical data compared to other manufacturers.

• Best For: Patients who dislike or cannot tolerate paresthesia, or those with diabetic neuropathy, fibromyalgia-like symptoms, or those seeking a novel non-traditional stimulation experience.

  
  

Patient-Centered Recommendations

✅ Best for Paresthesia-Free Therapy:

• Nevro HFX™ – reliable 10 kHz therapy without sensation.

• Abbott Proclaim™ – BurstDR™ is paresthesia-free with data support.

✅ Best for MRI Safety & Low Maintenance:

• Abbott Proclaim XR™ – full-body MRI, long-lasting non-rechargeable battery.

• Medtronic Vanta™ – adaptive, recharge-free, MRI-safe.

✅ Best for Rapid Relief:

• Boston Scientific WaveWriter Alpha™ – FAST therapy with near-immediate effects.

✅ Best for Customization & Multiple Pain Types:

• Boston Scientific and Medtronic – multi-modal waveform libraries.

  
  

Conclusion

Each spinal cord stimulator brand offers unique advantages tailored to different pain phenotypes, patient lifestyles, and anatomical needs:

• Medtronic: Ideal for those needing adaptive therapy and high customization.

• Abbott: Best for patients seeking paresthesia-free relief with long battery life and evidence-based therapy.

• Boston Scientific: Optimal for patients needing rapid relief or those who want multi-modal programming.

• Nevro: The leader in paresthesia-free high-frequency stimulation, especially for patients with painful diabetic neuropathy or non-surgical back pain.

  
  

Ultimately, the best choice depends on the patient’s pain characteristics, treatment goals, and lifestyle preferences. A detailed discussion with a pain specialist is essential to optimize outcomes and long-term satisfaction.

If you're considering spinal cord stimulation or want to learn more about which system may be right for you, contact Parkview Pain and Regenerative Institute to schedule a personalized consultation.