Peripheral Nerve Stimulator

Introduction

Peripheral Nerve Stimulators (PNS) are innovative medical devices designed to manage chronic pain by delivering mild electrical impulses to targeted peripheral nerves. This technique, known as neuromodulation, disrupts pain signals before they reach the brain, providing significant relief for patients suffering from various chronic pain conditions. PNS provides a non-opioid alternative for managing chronic pain, offering significant relief and improving the quality of life for patients with these conditions.

Clinical Indications

Peripheral Nerve Stimulators (PNS) are used to treat a variety of chronic pain conditions, particularly those involving nerve damage or dysfunction. Here are some common clinical indications:

Neuropathic Pain: Pain resulting from nerve damage, such as diabetic neuropathy, post-herpetic neuralgia, and chemotherapy-induced peripheral neuropathy.
Complex Regional Pain Syndrome (CRPS): A chronic pain condition often affecting the limbs, characterized by severe pain, swelling, and changes in skin color and temperature.
Failed Back Surgery Syndrome (FBSS): Persistent pain following back surgery, which may not respond to conventional treatments.
Post-Surgical Pain: Pain following surgeries such as total knee arthroplasty, anterior cruciate ligament (ACL) surgery, hernia repair, and mastectomy.
Chronic Shoulder Pain: Persistent pain in the shoulder region that does not respond to other treatments.
Chronic Pelvic Pain: Pain in the pelvic region, often associated with conditions like endometriosis or pelvic inflammatory disease.
Chronic Headaches and Migraines: Severe and recurrent headaches that do not respond to medication.
Chronic Knee Pain: Pain in the knee joint, often due to osteoarthritis or post-surgical pain.
Chronic Ankle/Foot Pain: Pain in the ankle joint, often due to osteoarthritis or post-surgical pain, or neuropathic pain in in feet.

Nerves that can be Targeted by PNS

Peripheral Nerve Stimulators (PNS) can be used to target the following nerves, each with specific therapeutic benefits for managing chronic pain:

Occipital Nerve

Indications: Used to treat chronic headaches, migraines, and occipital neuralgia.
Benefits: Provides significant pain relief in the back of the head and neck.

Suprascapular Nerve

Indications: Used for chronic shoulder pain, rotator cuff injuries, and shoulder arthritis.
Benefits: Reduces pain and improves shoulder mobility.

Cluneal Nerve

Indications: Used for chronic lower back pain and buttock pain.
Benefits: Alleviates persistent pain in the lower back and upper buttocks.

Genicular Nerve

Indications: Used for chronic knee pain, including pain from osteoarthritis and post-surgical pain.
Benefits: Provides targeted pain relief to the knee joint.

Tibial Nerve

Indications: Used for chronic pain in the lower leg and foot, including plantar fasciitis and tarsal tunnel syndrome.
Benefits: Reduces pain and improves mobility in the lower leg and foot.

Techniques and Goals

PNS involves the placement of a small lead wire near the affected nerve using ultrasound or fluoroscopic image guidance. The lead is connected to a wearable stimulator, which the patient can control remotely. The goal is to modulate nerve activity, reducing pain perception and improving the patient's quality of life

Therapeutic value & Effects

Therapeutic Value: PNS offers significant therapeutic value by providing a non-opioid alternative for pain management. Studies have shown that PNS can lead to substantial pain relief, with many patients experiencing a reduction in pain of at least 50%. This relief can endure well beyond the therapy period, sometimes lasting several years.

Duration of Effects: The effects of PNS can last for varying durations, depending on the individual and the condition being treated. Some patients may experience relief for up to 60 days with temporary systems, while permanent systems can provide ongoing pain relief for several months to years depending on the individual and the condition being treated.

Possible Side Effects or Complications

While PNS is generally safe, some potential side effects and complications may include:

Infection: At the site of lead placement.
Bleeding: Minor bleeding may occur during the procedure.
Nerve damage: Rare but possible if the lead is improperly placed.
Device-related issues: Such as lead migration or malfunction.

What to Expect

Patient Experience: When a patient comes to the clinic for PNS, they can expect a thorough evaluation to determine their candidacy for the procedure. The procedure itself is minimally invasive and typically performed on an outpatient basis, often performed under local anesthesia. A small lead is placed near the targeted nerve using ultrasound or fluoroscopic guidance, and the stimulator is activated to disrupt pain signals. Patients may feel a tingling sensation or a comfortable massaging feeling over the targeted nerve area once the stimulator is activated.

Procedure Duration: The PNS procedure usually takes about an hour, including the placement of the lead and the activation of the stimulator. The patient can then adjust the stimulation settings to achieve optimal pain relief.

We are here to help you

At the Institute of Interventional Pain Management, we are dedicated to helping patients with chronic pain by offering all types of peripheral nerve stimulators. Our team of experts is committed to providing personalized care and ensuring that each patient receives the most effective pain management solution.