The last 30 years have witnessed the growth of spinal cord stimulation as a treatment modality for an increasing number of chronic pain conditions. In spite of this growth, one of the greatest criticisms is the lack of concrete evidence for the mechanism of action. With the ever increasing enlightenment with regards to the neurophysiology of pain, and the development of more dynamic neuroimaging techniques, the opportunity to better define the mechanism of action of the spinal cord stimulator will continue to expand. In the interim, clinicians will benefit from the consolidation of the available knowledge that will enhance the effective use of the device. This review serves to provide an overview of the key principles of electrical stimulation and dorsal column mapping as it relates to spinal cord stimulation. We aim at enhancing the understanding regarding the basis for successful placement of leads and manipulation of electrical parameters.