Peripheral Nerve Stimulators

Peripheral nerve stimulation (PNS) is a technique for managing chronic pain by placing small electrodes near a specific peripheral nerve (a nerve outside of the spinal cord and brain) that is causing pain. These electrodes deliver mild electrical pulses to the nerve, interrupting pain signals before they reach the brain. PNS may be a treatment option for patients with chronic pain conditions who have not found relief with other methods.

What Conditions Can a Peripheral Nerve Stimulator Help With?

Peripheral nerve stimulators can help with various types of chronic pain, including:

• Nerve pain in the arms or legs (e.g., from peripheral neuropathy or injury)
• Headache and migraine pain
• Complex Regional Pain Syndrome (CRPS)
• Pain from nerve injury or trauma that hasn’t responded to other treatments

PNS is typically considered after non-surgical pain management options, such as physical therapy, medications, or injections, have been exhausted.

Procedure Overview

The process of obtaining a PNS involves two main stages: a trial phase and, if successful, a permanent implantation phase.

1. The Trial Phase

The trial phase allows you to experience the benefits of peripheral nerve stimulation before committing to a permanent implant. This procedure is minimally invasive and is generally performed in an outpatient setting, often taking about an hour.

Steps of the Trial Procedure:

• Preparation and Anesthesia: Local anesthesia or mild sedation may be used.
• Electrode Placement: The physician inserts a thin wire (lead) near the targeted peripheral nerve using a small needle. Imaging guidance, like ultrasound, is often used to ensure accurate placement.
• Temporary Device Connection: The lead is connected to an external device worn outside your body. This device generates electrical pulses and is worn for about 5-7 days during the trial period.

During the trial, you will evaluate how well the PNS reduces your pain, improves mobility, and enhances your daily function. If you experience significant relief, you may choose to proceed with a permanent implant.

2. Permanent Implantation

If the trial is successful, you can move forward with the permanent implantation of a PNS device. This procedure is also minimally invasive, typically performed in an outpatient setting, and takes about 1-2 hours.

Steps of Permanent Implantation:

• Anesthesia: Local anesthesia or light sedation may be used, based on your needs.
• Lead Placement: A thin lead is implanted near the nerve, targeting the pain source area.
• Implantable Pulse Generator (IPG): A small battery-operated device, about the size of a pacemaker, is implanted under the skin in a location such as the upper buttock or abdomen, depending on the pain location. This device generates electrical pulses and is connected to the lead(s).
• Programming: The device is programmed to deliver the optimal level of stimulation based on your specific needs and the location of your pain.

Most patients can go home the same day or within 24 hours of the procedure.

Pre-Requisites for Peripheral Nerve Stimulator Placement

Before undergoing PNS implantation, there are a few prerequisites to ensure your suitability and safety for the procedure:

• Bloodwork and Medical Evaluation: Routine blood tests are often required to confirm you are in good health for surgery and healing.
• Psychological Evaluation: A psychological assessment may be required, as chronic pain can impact mental health. This assessment helps determine if you are a suitable candidate for PNS and understand the expected outcomes and responsibilities of managing the device.

Post-Procedure Information

When Can I Go Home?

• For the trial phase, you’ll generally be able to go home the same day.
• For the permanent implantation, most patients can go home the same day or within 24 hours.

After the Procedure

• Activity Restrictions: After permanent implantation, avoid heavy lifting, bending, and twisting to allow for proper healing and avoid lead displacement.
• Pain Management: You may experience mild soreness at the implant site, which can be managed with pain medications prescribed by your physician.
• Follow-Up Appointments: Follow-up appointments will allow your physician to adjust the device settings for optimal pain relief. These appointments are also important for monitoring the healing process and device function.

Final thoughts

Many patients who undergo PNS report significant improvement in pain, increased mobility, and a better quality of life. The degree of pain relief can vary, but with PNS, the settings can be adjusted over time to improve the effectiveness of the treatment. The device may need reprogramming if your pain levels or pain locations change.

If you have any questions about your recovery or if you need further guidance after the procedure, please do not hesitate to contact our office.