Transcutaneous Spinal Cord Stimulation: What Patients Need to Know
You may have seen headlines about people with paralysis taking steps again, often mentioning spinal cord stimulation as part of their recovery. These stories are inspiring — and they raise important questions. What exactly is spinal cord stimulation? Is there a non-invasive option? And could it help you or someone you care about?
This article explains transcutaneous spinal cord stimulation (tSCS), a non-surgical approach that is generating significant interest in the spinal cord injury community. We'll explore what it is, how it differs from implanted stimulation, what the current research shows — including applications for pain and spasticity management — and what questions you might want to discuss with your clinical team.
Understanding Spinal Cord Stimulation
What Happens After Spinal Cord Injury?
When the spinal cord is injured, the communication pathway between the brain and the body is disrupted. Depending on the level and completeness of the injury, this can result in loss of movement, sensation, or both below the level of injury. But the consequences extend beyond movement — many people with spinal cord injury also experience:
- Neuropathic pain — burning, shooting, or stabbing pain caused by damage to the nervous system
- Spasticity — involuntary muscle stiffness, spasms, or jerking movements
- Changes in sensation — numbness, tingling, or altered feeling
These secondary effects can significantly impact quality of life, sleep, and daily function — sometimes more than the loss of movement itself.
For many years, it was believed that if nerve pathways were damaged, recovery was extremely limited. However, research over the past two decades has revealed something remarkable: in many cases, some nerve fibres and spinal circuits remain intact but are simply "dormant" — they're there, but they're not receiving enough input to activate.
This is where spinal cord stimulation comes in.
The Principle Behind Spinal Cord Stimulation
Spinal cord stimulation works by delivering electrical current to the spinal cord, which can influence how neural circuits function. Depending on the stimulation parameters and electrode placement, this can:
- Help activate dormant motor circuits
- Modulate pain signalling pathways
- Reduce excessive neural activity that causes spasticity
The spinal cord isn't just a passive cable connecting the brain to the body — it contains its own networks of neurons that process sensory information, coordinate movements, and regulate muscle tone. Spinal stimulation can influence all of these functions.
Implanted vs Transcutaneous: Two Approaches
Epidural (Implanted) Spinal Cord Stimulation
The approach that has generated the most dramatic headlines involves surgically implanting electrodes directly onto the surface of the spinal cord (the epidural space). This is called **epidural spinal cord stimulation (eSCS)** and was devised to target severe pain.
Epidural stimulation has produced remarkable results in carefully selected research participants, with some individuals regaining the ability to stand and take steps with support. However, it requires:
- Major spinal surgery
- Implantation of electrodes and a pulse generator
- Significant cost (often not covered by healthcare systems)
- Ongoing management and programming
This approach remains primarily available through research studies and specialist centres.
Transcutaneous Spinal Cord Stimulation (tSCS)
Transcutaneous spinal cord stimulation offers a non-invasive alternative. Instead of surgically implanting electrodes, tSCS delivers electrical current through electrodes placed on the skin over the spine.
The key advantages of tSCS include:
No surgery required — electrodes are simply placed on the skin
Reversible and adjustable — settings can be changed easily, and the treatment can be stopped at any time
Lower cost — no surgical or implantation expenses
Can be used at home — with appropriate equipment and training, tSCS can become part of a home-based programme
Accessible — more widely available than implanted systems
While tSCS may not achieve the same intensity of stimulation as implanted electrodes, research suggests it can still influence spinal circuits and produce meaningful benefits when used appropriately.
What Can tSCS Help With?
Transcutaneous spinal cord stimulation is being explored and used for several different purposes. It's essential to understand the distinction between licensed clinical applications and ongoing research areas.
Licensed Applications: Pain and Spasticity
Some tSCS devices are specifically indicated for:
Neuropathic Pain
Neuropathic pain after spinal cord injury can be one of the most challenging symptoms to manage. It often responds poorly to standard painkillers and can significantly affect quality of life, mood, and sleep. Spinal cord stimulation has a long history of use for pain management, and transcutaneous approaches offer a non-invasive option.
tSCS for pain works by modulating the way pain signals are processed in the spinal cord — essentially changing the "volume" on pain pathways. For some people, this can provide meaningful relief that complements other pain management strategies.
Severe Spasms and Spasticity
Spasticity — involuntary muscle stiffness and spasms — is common after spinal cord injury and can range from mild to severely disabling. While some spasticity can be functionally useful (helping with transfers or standing), severe spasms can cause pain, disrupt sleep, and interfere with daily activities.
tSCS can help modulate the spinal circuits that control muscle tone, potentially reducing the frequency and severity of spasms. This may reduce the need for oral anti-spasticity medications, which often cause unwanted side effects like drowsiness and weakness.
Research Applications: Movement and Function
Beyond pain and spasticity, researchers are actively investigating whether tSCS can help improve voluntary movement and function. Studies have shown promising results, including:
Improved voluntary leg movements in people with incomplete spinal cord injury
Enhanced effects of rehabilitation when tSCS is used alongside physical therapy
Improved trunk control and sitting balance
Support for stepping movements on a treadmill with body weight support
However, it's important to note that these functional applications are still largely in the research phase. While results are encouraging, outcomes vary significantly between individuals, and more evidence is needed to understand who benefits most.
The most honest summary is this: tSCS is an established tool for managing neuropathic pain and spasticity, with promising but still-evolving evidence for functional improvements.
tSCS for Upper Limb Function: The ARC-EX System
While much of the early tSCS research focused on the lower limbs and walking, there is growing interest in stimulation targeting the cervical (neck) region of the spinal cord to improve arm and hand function.
ONWARD Medical's ARC-EX
The ARC-EX system from ONWARD Medical is a non-invasive spinal cord stimulation device specifically designed for people with cervical spinal cord injuries affecting arm and hand function. The ARC-EX has received both FDA clearance (December 2024) in the United States and CE Mark certification under the European Union Medical Device Regulation (MDR) for improving hand sensation and strength in people with chronic incomplete cervical spinal cord injury.
Key findings from the Up-LIFT clinical study showed:
90% of participants experienced improvements in hand strength or function
87% reported enhanced quality of life
The device can be used both in clinical settings and at home
The ARC-EX delivers programmed electrical stimulation to the cervical spinal cord through electrodes placed on the skin at the back of the neck. It represents a significant development for people whose primary goals involve hand function — activities such as gripping, manipulating objects, and self-care tasks that are essential for independence.
If improving hand and arm function is a priority for you, the ARC-EX system may be worth discussing with your clinical team. It is currently available in the United States. In Europe, commercial availability is expected from Q4 2025, starting with Germany and expanding to other countries thereafter.
How tSCS Is Delivered
The Equipment
Transcutaneous spinal cord stimulation requires a stimulator capable of delivering the specific electrical parameters needed to influence spinal circuits. This typically includes:
Different parameters from standard TENS devices
Specific waveforms and frequencies designed to target spinal neurons
Electrodes placed over the spine (over the cervical, thoracic, or lumbar vertebrae, depending on the goals)
A reference electrode placed elsewhere on the body (often on the abdomen or shoulder)
Not all electrical stimulators are suitable for tSCS. The device needs to be able to deliver appropriate current at the required settings for the intended application.
The Stim2Go: For Pain and Spasticity Management
The Stim2Go from Pajunk and SensorStim is available from Anatomical Concepts. This device is a portable, multi-channel stimulation system capable of delivering transcutaneous spinal cord stimulation. The Stim2Go is indicated for neuropathic pain and severe spasms — two of the most challenging secondary complications of spinal cord injury.
Key features of the Stim2Go for tSCS include:
Adjustable parameters — intensity, frequency, and pulse width can be tailored to individual needs
Portable design — can be used at home, making regular sessions practical
Multiple channels — allows for different electrode configurations
Designed for home use — empowering patients to manage symptoms between clinic visits
Established clinical application — for the licensed indications of neuropathic pain and spasticity
For people struggling with pain or spasms that aren't well-controlled with medication alone, the Stim2Go offers a non-pharmacological option that can be integrated into daily life. As with any treatment, it works better for some people than others, and a trial period with clinical support is typically recommended.
If you're interested in exploring tSCS for pain or spasticity management, discuss the Stim2Go with your clinical team.
Combining tSCS with Other Treatments
A Multimodal Approach
Most people with spinal cord injury benefit from a combination of approaches rather than relying on any single treatment. tSCS can be part of a broader management plan that might include:
Physiotherapy — maintaining range of motion, strength, and function
Medication — for pain, spasticity, or other symptoms (potentially at lower doses if tSCS helps)
FES cycling or standing programmes — for cardiovascular health and muscle maintenance
Psychological support — for the emotional aspects of living with spinal cord injury
For those exploring tSCS for functional improvements (in research settings or off-label use), active rehabilitation alongside stimulation appears to be important. The stimulation may create a "window of opportunity" where the spinal cord is more responsive, but rehabilitation provides the training that drives lasting change.
What a tSCS Programme Might Look Like
A tSCS programme for pain or spasticity, guided by a clinical team, might include:
1. Pre Assessment — understanding your symptoms, current treatments, and goals
2. Testing — testing whether tSCS provides a meaningful benefit for you
3. Parameter optimisation — finding the settings that work best
4. Home programme — regular use at home as part of your daily routine
5. Regular review — adjusting the programme based on your response
The specifics will vary depending on your individual situation.
Is tSCS Right for You?
Who Might Benefit?
tSCS for pain and spasticity may be helpful for people with:
- Neuropathic pain that isn't well controlled with medication
- Severe spasms affecting sleep, comfort, or function
- A desire to reduce reliance on oral medications
- Spinal cord injury at various levels (cervical, thoracic, or lumbar)
- Both recent and long-standing injuries
For upper limb function (with systems like the ARC-EX), candidates typically have incomplete cervical spinal cord injury with some preserved sensation or movement.
Who Should Be Cautious?
tSCS may not be suitable if you have:
- A pacemaker or other implanted electrical device
- Skin problems over the electrode placement area
- Severe autonomic dysreflexia that is poorly managed
- Certain other medical conditions (your clinical team can advise)
- Epilepsy or a history of seizures (for some applications)
A thorough assessment is essential before starting any tSCS programme.
Questions to Ask Your Clinical Team
If you're interested in exploring transcutaneous spinal cord stimulation, here are some questions you might want to discuss with your physiotherapist, rehabilitation consultant, or spinal injury team:
1. Would tSCS be appropriate for managing my pain or spasms?
2. What outcomes might I realistically expect?
3. Could I trial the treatment before committing to purchasing equipment?
4. What equipment would I need, and is it available through the NHS or would I need to fund it privately
5. How does tSCS compare to my current medications, and could it allow me to reduce doses?
6. Who would supervise my programme and how often would I be reviewed?
7. Are there research studies for functional applications that I could participate in?
8. Is the ARC-EX system available for upper limb applications, and would I be a candidate?
Your clinical team can help you weigh the potential benefits against the practical considerations and ensure any programme is safe and appropriate for you.
Summary
Transcutaneous spinal cord stimulation is an established and evolving tool in spinal cord injury management. By delivering electrical current through electrodes placed on the skin, tSCS can influence spinal circuits without the need for surgery.
Key points to remember:
tSCS is a non-invasive alternative to implanted spinal cord stimulation
Licensed applications include the management of neuropathic pain and severe spasms
The Stim2Go from Anatomical Concepts is indicated for neuropathic pain and spasticity
Research is ongoing into functional applications such as improving movement
The ARC-EX from ONWARD Medical targets upper limb function in cervical injuries
Results vary between individuals — a trial is often recommended
tSCS works best as part of a comprehensive management plan
Always work with your clinical team to determine if tSCS is appropriate for you
The field is evolving rapidly, with new devices and research expanding our understanding of what's possible. If you're struggling with pain, spasms, or loss of function after spinal cord injury, speak with your rehabilitation team about whether tSCS might be part of your management plan.
Further Resources
Anatomical Concepts UK — (https://www.anatomicalconcepts.com) — information on the Stim2Go and other rehabilitation products
ONWARD Medical** — [onwd.com](https://www.onwd.com) — information on the ARC-EX system for upper limb function
*This information is for general guidance only and should not replace advice from your healthcare team. Always consult your clinician before starting any new treatment or exercise programme.*