It is estimated that as many as 50,000 spinal cord stimulators are implanted annually and the clinical demand for SCS continues to increase. SCS has also proven effective for visceral pain, including refractory angina, and peripheral vascular disease. failed back surgery syndrome or complex regional pain syndrome). Spinal cord stimulation (SCS) is a pain management therapy approved by the United States Food and Drug Administration (FDA) for a primary indication of neuropathic limb pain that is refractory to conventional medical management (e.g. To optimize both system designs and clinical implementations of SCS, it is critical that we address these scientific and mechanistic knowledge gaps. We also lack information-rich biomarkers of pain and pain relief through which to optimize SCS programming. We still do not know why SCS works in some patients but not in others. While it is an exciting time for the neuromodulation field, empirical SCS advances have surpassed scientific understanding of SCS mechanisms of action. To improve SCS outcomes, advances in lead design, stimulator features, and waveform paradigms have been recently introduced. Although available for decades, SCS still enjoys only limited clinical success, limited quality-of-life improvement, and limited long-term efficacy. The goal of SCS is to modulate neural signaling through spinal and supraspinal mechanisms to reduce pain. In SCS, an implanted pulse generator produces electrical signals that are conveyed through electrode arrays located in the region of the spinal cord. Spinal cord stimulation (SCS) is a neuromodulation therapy used to treat medically refractory chronic pain.