Pain can frequently be managed by non-surgical therapies such as oral medications, injections, and nerve blocks. However, when these options fail to alleviate pain, peripheral nerve stimulation (PNS) may be an appropriate alternative.
Like spinal cord stimulation, peripheral nerve stimulation is a non-medicinal approach that uses mild electrical stimulation to mask pain signals before they reach the brain. However, peripheral nerve stimulation (PNS) differs from spinal cord stimulation because it places the stimulating devices directly over the nerve at the targeted pain area, not on the spinal cord where the nerve originates.
The configurations of currently available peripheral nerve stimulation systems vary widely. Some are intended for long term use, and others are designed to be used for short periods before removal. The Mayo Clinic has found that clinical research demonstrates that peripheral nerve stimulation may be used effectively in the management of acute as well as chronic pain, and that stimulation for up to 60 days can provide significant and sustained relief after use has ended.
Advances in peripheral nerve stimulation technologies are ongoing constantly, with manufacturers consistently making changes in their products to enhance the capabilities of devices.
Who Is a Good Candidate?
Due to its minimally invasive nature, peripheral nerve stimulation is an appropriate alternative that can be considered early in clinical care pathways. In simpler terms, this means that it appropriately can be one of the first options a doctor might consider for the treatment of a patient suffering with peipheral nerve pain. Peripheral nerve stimulation is being used for cases such as:
- Post-operative joint pain
- Post-joint replacement pain
- Low back pain
- Inoperable joint pain
- Complex Regional Pain Syndrome (CRPS)
- Post amputation pain
- Nerve trauma
- Mononeuropathies (damage to a single nerve)
Patients considering peripheral nerve stimulation should have realistic expectations for results. Peripheral nerve stimulation relieves symptoms, but it is not a cure.
Trial Period
After screening that a patient is an appropriate candidate for peripheral nerve stimulation, a trial run is first started to test a patient’s response to the therapy. Temporary electrodes are placed along the length of the peripheral nerve identified as causing the pain.
The trial lasts typically three to ten days, after which time the electrodes are removed in a simple office procedure. If the underlying pain subsides significantly during the trial, and the patient is comfortable with the sensations they experience with pain relief, then a permanent implantation is scheduled.
Implant Procedure
The permanent implant procedure for a peripheral nerve stimulator is done on an outpatient basis. Given the wide variety of peripheral nerve stimulation systems on the market, the specific implantation procedures vary according to what is appropriate for the underlying device.
Non-Permanent Peripheral Nerve Stimulators
There are some peripheral nerve stimulators that are designed not to require permanent implantation. After a period of short-term treatment, the leads for these non-permanent peripheral nerve stimulators are removed. Patients then continue their lives without using neurostimulation. Clinical research has shown that after a 60-day neurostimulation treatment phase, pain relief remained when patients had their 12 month follow-up checkup.
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