• The technology described in this briefing is Evoke Spinal Cord Stimulator System. It is used for managing chronic neuropathic or ischaemic pain.

  • The innovative aspects are that Evoke uses a 'closed-loop' feedback control. It does this by recording activation of neural tissue and automatically adjusting stimulation to ensure it remains in the therapeutic range.

  • The intended place in therapy would be as a replacement or alternative to current open-loop (fixed-output) spinal cord stimulation therapy in people with leg and back pain.

  • The main points from the evidence summarised in this briefing are from 2 studies: a randomised controlled trial and an observational study, including a total of 184 adults with intractable back and leg pain. They show that Evoke is more effective than open-loop spinal cord stimulation in people with intractable back and leg pain.

  • Key uncertainties around the evidence are that there are no studies reporting the economic impact of Evoke.

  • The cost of Evoke ranges from £17,595 to £19,395 for the device. The trial phase cost ranges from £1,920 to £4,975. The resource impact would be comparable with standard care, which ranges from £13,726 to £22,418 for a rechargeable spinal cord stimulation system.