Spinal cord stimulation (SCS) is an accepted treatment for certain chronic pain syndromes. It is imperative that patients undergo a stimulation screening trial. For trial stimulation, typically patients undergo a percutaneous lead placement. Due to technical considerations, there exists a subset of patients who are not candidates for a percutaneous trial. We present our experience with open paddle trial for spinal cord stimulation and review the characteristics of this patient population as well as the technique and efficacy of an open paddle lead trial for spinal cord stimulation. Retrospective review. University of Texas Southwestern Medical Center, Department of Neurosurgery. We retrospectively identified 25 patients undergoing a paddle lead trial for spinal cord stimulation from September 2014 to September 2019. Twenty-five patients underwent a paddle lead trial for spinal cord stimulation. The average age was 61 with a range of 40 to 82 years; 19 were women and 6 were men. Twenty-two patients (88%) had failed back surgery syndrome (FBSS). Nine patients had attempted percutaneous trials that were unsuccessful, and 14 patients had extensive hardware and/or scar tissue, necessitating an open paddle trial. Twenty-three (92%) patients had a positive trial and went on to permanent implantation. The retrospective nature is a major limitation as well as loss to follow-up on several patients. Patients, who have either failed or are deemed suboptimal for percutaneous trialing for spinal cord stimulation, should be considered for open paddle lead trialing. A multidisciplinary approach improves communication and helps to identify that subset of patients who otherwise may be left to pursue conservative measures only.