Procedures & Treatment Options
Peripheral Nerve Stimulation
Evaluation.
Peripheral nerve stimulation is an advanced pain management option for selected patients with chronic peripheral nerve pain. A thorough evaluation is required to determine whether peripheral nerve stimulation is appropriate for any individual patient.
In Brief
What it is
An evaluation to determine whether peripheral nerve stimulation (PNS) — an implantable device that delivers electrical stimulation to peripheral nerves — may be appropriate for chronic pain management.
When it may be considered
In selected patients with chronic peripheral nerve pain that has not responded adequately to conservative treatment and other interventional options, after comprehensive clinical evaluation.
What to expect
The evaluation includes a thorough history, physical examination, review of prior treatments, and discussion of potential benefits and limitations. If appropriate, a trial of temporary nerve stimulation may be offered to assess response before considering implantation.
Overview
What Is Peripheral Nerve Stimulation?
Peripheral nerve stimulation (PNS) is a neuromodulation treatment where an electrode is placed near a peripheral nerve, and a small implantable generator delivers electrical pulses to that nerve. The stimulation is thought to interfere with pain signal transmission or modulate pain perception.
PNS systems consist of an implanted generator (power source) placed under the skin, electrodes that contact the nerve, and a remote control that allows the patient to adjust stimulation parameters. The system can be programmed and adjusted to optimize pain relief for the individual patient.
Indications
When PNS Evaluation May Be Appropriate.
Peripheral nerve stimulation evaluation may be considered for selected patients with:
- Chronic peripheral nerve pain that has not responded to conservative treatment
- Pain in the distribution of a specific peripheral nerve
- Inadequate response to medications and other interventional procedures
- Conditions where other advanced pain management options have been exhausted or are not appropriate
- Strong motivation to pursue advanced pain management and willingness to participate in trial and potential implantation
Comprehensive clinical evaluation is required to determine candidacy for PNS.
Evaluation
The Peripheral Nerve Stimulation Evaluation.
The evaluation begins with a comprehensive history including the character of pain, duration, location, prior treatments, response to medications and prior procedures, and impact on function. Physical examination helps identify the specific nerve(s) responsible for pain.
Imaging and prior diagnostic testing results are reviewed. The physician assesses whether the patient is a candidate for PNS and discusses potential benefits and limitations. If appropriate, a trial may be offered to test whether PNS provides adequate pain relief before considering implantation.
Trial & Implant
Trial Period and Implantation Consideration.
If evaluation suggests PNS may be beneficial, a trial period may be recommended. During trial, a temporary electrode is percutaneously placed near the target nerve, connected to an external generator. The patient tests stimulation at home for several days to assess pain relief. A successful trial (typically defined as 50% or greater pain relief) suggests candidacy for permanent implantation.
If the trial is successful and the patient wishes to proceed, permanent implantation of the PNS system is a surgical procedure. Not all patients who undergo trial proceed to implantation — some may decline after trial or may not meet implantation criteria.
Questions
Frequently Asked Questions.
What is peripheral nerve stimulation?
Peripheral nerve stimulation (PNS) is an implantable device-based treatment where a small electrode is placed near the peripheral nerve causing pain, and a small generator delivers electrical stimulation to that nerve. The stimulation may interfere with pain signals or modulate pain perception.
How is peripheral nerve stimulation different from spinal cord stimulation?
Both are neuromodulation treatments using electrical stimulation to address pain. Spinal cord stimulation targets nerves in the spinal cord, while peripheral nerve stimulation targets specific peripheral nerves in the periphery. The choice between them depends on the pain condition and location.
What does a trial consist of?
A trial (also called a screening or evaluation) typically involves percutaneous placement of a temporary electrode near the target nerve. The patient tests the stimulation for several days to a week to assess whether it provides adequate pain relief. If successful, a permanent system may then be considered.
How is the device controlled?
Once implanted, the peripheral nerve stimulation system includes a small generator implanted under the skin and a remote control that allows the patient to adjust stimulation settings. Patients learn to control the device to optimize pain relief.
Is implantation required?
A trial does not require implantation — it uses temporary leads. If the trial is successful and both patient and physician agree that implantation is appropriate, then a permanent system can be surgically implanted. Not all patients proceed to implantation.
What are the limitations?
Peripheral nerve stimulation does not cure the underlying condition. Response varies widely and cannot be predicted before trial. The device requires programming and maintenance. Long-term effectiveness data is still developing for many indications.
Information
Important Information.
Peripheral nerve stimulation does not cure the underlying condition causing nerve pain. Response to PNS varies widely and cannot be predicted in advance. Some patients experience significant pain relief while others experience minimal relief. Long-term effectiveness data is still developing for many indications.
Implantation of a PNS system is a surgical procedure carrying surgical risks. The device requires ongoing management including programming, battery monitoring, and potential replacement. Insurance coverage for PNS varies; some plans may not cover the procedure or may have specific coverage criteria.
A comprehensive clinical evaluation is required to determine whether peripheral nerve stimulation evaluation is appropriate for any individual patient. This page is for general informational purposes only and does not constitute medical advice or create a physician-patient relationship.
Dr. Dardashti sees patients in Mission Hills, California, serving patients from the San Fernando Valley, Santa Clarita Valley, and surrounding Los Angeles communities.
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