The term spinal cord stimulation (SCS) describes the electrical stimulation of the dorsal column via electrode arrays implanted in the epidural space of a spinal level associated with a painful dermatome. Conventional SCS uses electrical pulses delivered at relatively low frequency (~50 Hz) using array designs that can be customized to patient needs. Electrical current can be adjusted to stimulate and induce paresthesias in large fibers of the dorsal columns, in turn closing the gate to the nociceptive fibers transmitting input to the brain. Recent stimulation paradigms (HF, burst) have shown to be clinically effective without the need for paresthesias, implying that the stimulating electrical field modulates pain signals via alternative mechanisms. SCS is a minimally invasive therapy that has proven to be effective for the treatment of chronic neuropathic pain in which conservative management has failed. Best levels of evidence support SCS efficacy in low back pain indications such as failed back surgery syndrome (FBSS), as well as in complex regional pain syndromes (CRPS). There is also evidence of positive outcomes for treating neuropathies, abdominal/pelvic pain, and ischemic-related pain syndromes. Technological advances in lead design, battery efficiency, and pulse programming, in combination with properly designed randomized clinical trials, will continue to make SCS an effective alternative therapy for chronic painful conditions.