OVERVIEW

What is Peripheral Nerve Stimulation (PNS)?

Peripheral Nerve Stimulation (PNS)is a form of neuromodulation used to treat chronic pain by targeting specific peripheral nerves. Unlike Spinal Cord Stimulation (SCS) which targets the central nervous system, PNS works by directly intervening at the level of the peripheral nerves that are associated with the pain pathways.

Indications

• Neuropathic Pain: Conditions such as trigeminal neuralgia, occipital neuralgia, and peripheral neuropathy.
• Trigeminal Neuralgia: Severe facial pain that follows the distribution of cranial nerves, primarily managed when other therapies have failed.
• Post-Surgical Pain: Persistent nerve pain following surgery.
• Complex Regional Pain Syndrome (CRPS): Especially for pain localized to a specific area such as a limb.

How does it Work?

• Device Components: PNS systems typically consist of small electrodes that are placed near the targeted peripheral nerves and a generator that delivers low-voltage electrical currents. The generator can be either an external device or an implantable unit.
• Electrode Placement: During a minimally invasive procedure, electrodes are implanted along the course of the peripheral nerve or nerves believed to be transmitting the pain signals. The placement is guided by imaging techniques such as ultrasound or fluoroscopy to ensure accuracy.
• Stimulation: Once in place, the electrodes emit electrical pulses that interfere with the nerve’s ability to send pain signals to the brain. The idea is to alter or block the nerve signals, which can effectively reduce the perception of pain.

What are the Procedure for Implanting an PNS Device?

• Trial Phase: Similar to spinal cord stimulation, a trial stimulation period may be conducted first, using a temporary electrode system to assess the effectiveness of the treatment for a specific patient.
• Implantation: If the trial is successful, a more permanent set of electrodes is implanted and connected to a pulse generator implanted under the skin, typically in a convenient location such as the buttocks or abdomen.
• Follow-up: Post-implantation, patients undergo follow-up appointments to adjust stimulation settings and assess the pain management and overall functionality.

What are the Benefits?

• Targeted Pain Relief: By focusing on specific nerves associated with pain, PNS can provide targeted relief without affecting other areas of the body.
• Minimally Invasive: The procedure to implant the electrodes is minimally invasive, often performed as an outpatient procedure with local anesthesia.
• Adjustable: The intensity of the stimulation can be adjusted according to the patient’s pain levels and response to therapy.
• Reversible: Unlike some surgical options, PNS devices can be turned off or removed if they are not effective, or if the patient’s condition changes.
• Reduced Dependency on Pain Medication: Effective PNS can decrease the need for chronic pain medications, including opioids.