Peripheral Nerve Stimulation

Good candidates have chronic pain — usually for at least three months — that follows a specific nerve or area, such as one shoulder, one knee or the lower back muscles, and has not improved with physical therapy, medicines or injections^[5]. A nerve block that temporarily relieves the pain is a good sign^[7]. PNS can also suit people who want to avoid a spinal implant. Widespread pain, an active infection or untreated substance use are reasons to wait or choose another treatment.

Electrical stimulation can reduce nerve pain for many people, but not everyone. A 2020 systematic review found 14 randomized trials of peripheral nerve stimulation and rated the evidence moderate to strong across conditions such as headache, shoulder, back and limb pain^[9]. In a small placebo-controlled trial after leg amputation, 6 of 9 people (67%) who received 60-day stimulation still had at least 50% less pain at 12 months^[10]. Results depend on choosing the right nerve and the right patient.

A peripheral nerve stimulator targets one nerve outside the spine, while a spinal cord stimulator places leads in the epidural space to cover larger areas, such as the back and both legs. PNS leads are placed through a needle, often with ultrasound, and some are removed after 60 days; spinal cord stimulators are implanted with a battery under the skin^[7]. PNS suits pain in a defined nerve territory, while spinal cord stimulation is often a better fit for widespread back and leg nerve pain.

A temporary percutaneous system is used for up to 60 days and then removed^[1]. The goal is relief that continues after the lead comes out, which one small trial found could last as long as 12 months^[10]. An implanted micro-PNS system is designed to stay in place long term, and you use its external power unit for as long as it helps. If relief from a 60-day course fades, a repeat course or an implanted system can be considered.

Most people feel only brief pressure or stinging, because the skin is numbed first and the lead goes in through a thin needle. Placement usually takes less than an hour. Once the stimulator is on, you typically feel a gentle tingling, buzzing or rhythmic muscle pulsing over the painful area. The intensity can be adjusted so it stays comfortable.

Tell us every medicine and supplement you take. PNS is generally considered a low- to intermediate-risk procedure for bleeding, so many patients continue blood thinners, but that decision belongs to your physician and the doctor who prescribed the medicine — never stop one on your own^[8][7]. Wear loose clothing that gives access to the area, and arrange a ride if you will receive sedation.

Most people return to normal light activities, including work, the next day. Protect the lead and bandage: avoid baths, pools and hot tubs, keep the site dry when showering as instructed, and avoid strenuous exercise that pulls on the area. Check the skin each day for redness or drainage, and change or charge the small stimulator battery as shown at your visit. The lead is removed in the office at the end of treatment.

Most side effects are minor: skin irritation from the bandage or adhesive, soreness or bruising where the lead enters, and occasionally an infection at the exit site. Leads can move or break; in one trial, 15% of leads fractured^[7]. Nerve injury and significant bleeding are uncommon^[7]. Call us right away for fever, spreading redness, drainage, or new numbness or weakness.

Coverage depends on the type of system and your plan. Medicare’s national policy covers implanted peripheral nerve stimulators under the prosthetic device benefit when its criteria are met^[3]. Commercial plans vary, especially for temporary 60-day systems, and almost always require prior authorization. New York workers’ compensation requires pre-authorization and criteria such as at least three months of focal nerve pain, failed conservative care and psychological screening^[5]. No-fault follows its own rules. We verify benefits and explain any costs before scheduling.

If PNS does not help, the lead is removed and other options remain. Depending on your pain, these may include radiofrequency ablation for back pain, genicular nerve ablation for knee pain, a suprascapular nerve block for shoulder pain, spinal cord stimulation for more widespread nerve pain, or non-invasive scrambler therapy for neuropathy. Physical therapy and medicines remain part of the plan.