Pain is a complex behavior process, the anatomy and physiology of which is not completely understood, and is subject to continuous exploration and research. Following on the heels of Melzack and Wall's gate control theory of pain (1965), Shealey et al., in 1967, were the first to implant stimulation electrodes over the dorsal columns in an attempt to provide relief for patients with chronic, intractable pain. Since then, significant strides in both the technological and therapeutic sides have facilitated the evolution of spinal cord stimulation (SCS) in the management of a variety of pain pathologies. High-quality evidence attests to the efficacy and cost–effectiveness of this modality. In contrast to conventional medical management, SCS offers long-lasting symptom relief, improved quality of life and functional capability, often achieving these goals at a reduced cost. This article illustrates the present status, challenges and future of SCS.