Peripheral nerve stimulation places small leads directly adjacent to a peripheral nerve outside the spinal canal to treat localized pain. Modern PNS systems have become significantly smaller and can be implanted through a simple needle-based procedure under ultrasound or fluoroscopic guidance.
Conditions treated include post-surgical nerve pain, peripheral neuropathy, post-amputation pain (including phantom limb and stump pain), chronic headache (occipital nerve stimulation), and chronic shoulder pain.
PNS technology has advanced substantially, with temporary systems providing a 60-day treatment period that can produce lasting neuromodulatory effects well beyond the stimulation period.
A small lead with one or more electrodes is placed percutaneously adjacent to the target peripheral nerve. The lead is connected to a small external pulse generator worn on the body. Electrical stimulation modulates the pain signals traveling along that nerve, replacing the sensation of pain with a gentle tingling or massage-like sensation.
For temporary PNS systems, the lead is removed after a 60-day treatment period, yet many patients continue to experience significant pain relief due to the neuromodulatory effects that persist after stimulation ceases.
The lead placement procedure is performed in the clinic or outpatient setting under ultrasound or fluoroscopic guidance. The procedure is minimally invasive and typically takes 20-30 minutes. Patients are awake during placement to provide feedback on stimulation coverage.
During the treatment period, patients control stimulation parameters and can adjust settings for optimal comfort and pain relief.
Activity restrictions during the lead placement period are minimal. Patients can work and perform normal daily activities. The lead exit site must be kept clean and dry. After the 60-day treatment period, the temporary lead is removed in the office.
For permanent systems, recovery is similar with slightly more activity restrictions during the initial healing period.
PNS is indicated for patients with focal neuropathic pain conditions. Contraindications include active infection at the proposed lead placement site, untreated coagulopathy, or conditions that would interfere with device operation.
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