Peripheral Nerve Stimulation

What Is Peripheral Nerve Stimulation?

Peripheral nerve stimulation (PNS) is a treatment for chronic pain that is used when other first-line pain management treatments, such as medications, physical therapy, and nerve blocks, have not previously worked. It is a common procedure and is considered to be very safe. There is no added risk of dependency forming that a patient may experience with opioid medications, which are often prescribed for pain. This is an outpatient procedure that is designed to help reduce pain specifically from damaged peripheral nerves.  

This procedure uses a small, electrical device known as a peripheral nerve stimulator implant. A pain management doctor will identify which peripheral nerves have been damaged and the device will be implanted next to the nerve to “stimulate,” it and keep pain signals from traveling along the nerve and into the brain. The electrical device acts in a similar manner to a pacemaker, which is implanted into a patient's heart, and delivers a series of fast electrical impulses to the nerve or multiple nerves, and the patient will feel nothing more than a tingling sensation. After the device is implanted, patients are able to control the amount of stimulation by turning it off and on or adjusting the levels of stimulation with a small remote control. With this implant, patients are often able to regain control of their symptoms and take back their life from their pain.  

What Are The Peripheral Nerves?

The peripheral nervous system is a network of nerves that are located outside the brain and spinal cord (or your central nervous system). The nerves in the peripheral nervous system branch out from the brain and spinal cord into all other parts of the body, your muscles and organs included. The two systems, the peripheral nervous system and central nervous system, work together by the nerves in the central nervous system sending information throughout the body via the nerves of the peripheral system so that these areas can react to stimuli. 

The peripheral nervous system is further divided into the somatic nervous system and the autonomic nervous system. The somatic nervous system includes the sensory nervous system and transmits signals from the different senses, such as taste and touch. The autonomic nervous system pertains to involuntary functions and organs, such as breathing and heart rate. 

The peripheral nerves are more susceptible to injury since they are not protected by the spinal column and skull, like the central nervous system is. When the peripheral nerves are damaged, it can lead to what is known as peripheral neuropathy.

Peripheral Neuropathy

Peripheral neuropathy is the direct result of a nerve injury and can cause disruptions to the brain’s ability to communicate with the muscles and organs. Peripheral neuropathy affects the systems that make up the peripheral nervous system, which are the motor nerves, sensory nerves, and autonomic nerves. Symptoms of peripheral neuropathy can be muscle weakness, painful cramps, possible muscle twitching, numbness (especially in the hands and/or feet), excessive sweating, fluctuations in blood pressure, and inability to tolerate temperature changes. 

Peripheral Nerve Stimulation Trial  

Once the patient decides to move forward with the procedure, they will need to follow certain steps first. The initial part of the process requires the patient to complete a psychological evaluation to ensure that they are emotionally ready to go through with the procedure, as elevated stress and anxiety levels can reduce the effectiveness of the peripheral nerve stimulator implant.  

When the patient has successfully completed the psychological evaluation and been deemed a good fit for the procedure, they will then move on to a trial run to gauge their response before the device is permanently implanted. The doctor will put the temporary peripheral nerve stimulator in the correct position using fluoroscopy, which creates a real-time video of the movements inside the body using x-ray technology. Instead of the actual device that is used during the later procedure, the temporary implant involves one or two electrodes (wires) and they are placed along the damaged peripheral nerve. This process is done as an outpatient procedure so the patient may leave the doctor’s office the same day. The trial will take place for around 3-5 days, allowing the patient to see if their pain and other symptoms subside and if they want to continue to the next phase. When the trial ends the temporary electrodes are removed.

The Peripheral Nerve Stimulation Procedure

After the trial period has been successfully completed, the patient will then be able to have the permanent device implanted and will require minimally invasive surgery. 

Before the procedure begins the patient will be taken to the operating room in order to be prepped by an attendant. The patient will also be able to ask any additional questions they may have. This prep time will involve cleaning the area of the back, in the exact location where the device will be inserted, with alcohol or another antiseptic solution. Local anesthesia will then be administered in order to numb the area and medication may also be given through an intravenous line (IV) in order to relax the patient if needed.   

While the patient is lying face down on the operating table a small incision will be made by the surgeon. The targeted nerve will be identified and a small needle will be used to insert the device under the skin. The device includes permanent electrodes with extension wires that are plugged into an internal pulse generator, also called a battery. When the stimulator is in place then the electrical pulse settings are adjusted to provide pain relief as quickly as possible and can continue to be adjusted later on to the level the patient needs. The entire procedure should be completed around an hour or less. 

Afterward, the patient will be discharged and may resume light daily activities after a few weeks, with a full recovery after 6-8 weeks. Even with restricted movement, it is encouraged for the patient to move enough to keep the muscles from becoming stiff, but avoid excessive bending and/or twisting. Also, they should avoid lifting heavy objects until the area is completely healed. The doctor will discuss all the things the patient should and should not do before they are discharged. 

The peripheral nerve stimulator has been clinically shown to provide significant relief from chronic pain and can allow patients to return to a good quality life. 

How To Get Started

If you would like more information about the benefits peripheral nerve stimulation or other pain management therapies we offer or our specialists, please call Pain and Spine Specialists and speak to our dedicated team to improve the quality of your life. You can Call Maryland offices (view maryland phones), Pennsylvania offices (view pennsylvania phones), or (540) 433-1905 (Virginia) and schedule an appointment today. If you would like a comprehensive overview of peripheral nerve stimulation prior to your appointment, then we recommend watching our latest PNS Webinar here.