The trial leads can be placed through a needle and then secured to the skin with occlusive dressing, or a staged approach can be used. In the staged method, once the leads are in place, a skin incision is made at the insertion site of the electrodes. The Tuohy needle can be left in place to protect the electrode from the scalpel at this point. The fascia is prepared towards the insertion site of the leads. The Tuohy needle is removed and an anchor is placed. The anchor is sutured to the fascia and the lead to minimize the risk of dislocation. The lead is connected to an extension lead, externalized, and connected to an external pulse generator. A trial is performed, usually lasting 7 days (depending on the clinical protocol). Frequencies for stimulation can vary from 2 to 10 kHz, with amplitudes 2–4 mA, and pulse widths 30–40 μs. Usually, the contacts above and below the T9-10 intervertebral disc are activated. The standardized stimulation protocol starts with a frequency of 10 kHz, an amplitude of 2 mA, and a pulse width of 30 μs. The amplitude is gradually increased during the trial phase. Pain reduction usually is initiated within the first 24–48 h after the start of stimulation.

When the patient achieves acceptable amounts of pain relief and wishes to move forward with a permanent implant, the patient is brought back to the operating room and the extension leads are removed. The internal pulse generator is placed in an epifascial gluteal or abdominal pocket and connected to the leads. Once the connection is secured and tested, all wounds are closed carefully.