Peripheral nerve stimulation (PNS) is a commonly used approach to treat pain. It involves a procedure that places a small electrical device (a wire-like electrode) that targets a named nerve or branch of a named nerve. (These are the nerves that are located beyond the brain or spinal cord). The electrode delivers electrical pulses to provide therapy either to create tingling (paresthesia) or non tingling (non-apresthesia) or a muscle response.
With the evolution of imaging modalities like Ultrasound the scope of PNS has increased markedly for upper and lower extremities, cranial, occipital, lumbar, sacral, genitofemoral, ilioinguinal, axial and segmental nerves. The ability to place leads percutaneously near the neural fascicles without open dissection has significantly reduced morbidity of scarring and the mechanical challenges of previous surgical systems. (1-3). The procedure is primarily done in office setting under local anesthesia. Peripheral Nerve Stimulation continues to evolve with accrual of more robustly designed studies. Several trials have been published in the last decade to further advance our understanding of this novel therapy with potential new targets (4).
Some of the accepted and relatively well studied targets for PNS can be succinctly discussed in the following table (5,6,7):
Spinal Nerve Root Stimulation
There are also published reports with successful use of PNS in a HYBRID neurostimulation paradigm for primarily axial low back pain in conjunction with Spinal Dorsal Column Stimulation (8,9).
The risks and benefits of the procedure should be individualized as per the comorbidities of patients and shared decision making should be encouraged in high risk patients (anticoagulation, high risk for infection, immunocompromised, cancer, etc).
The field of peripheral nerve stimulation is undergoing metamorphosis at a very rapid pace. Advancements into new indications, new stimulation targets and new device designs will expand the window of opportunity to attract more neuromodulators interested in the field of Peripheral Nerve Stimulation. The turning point, however, will not occur until sufficient scientific evidence is gathered to unequivocally prove its safety, clinical efficacy and cost effectiveness (10). For more information on Peripheral Nerve Stimulation, click here.
