Peripheral Nerve Stimulator Trial and Implant
Indications – Peripheral Nerve Stimulation (PNS) is indicated to manage chronic, intractable pain after attempts to cure the underlying condition are ineffective including medication management, physical therapy, psychological therapy, injections, or potentially surgery. In general, severe neuropathic pain responds well to PNS.
Procedure – PNS involves implanting a neurostimulator lead near the anatomic location of a peripheral nerve. The peripheral nerve stimulator lead is then connected to a external pulse generator which then uses electrical stimulation to modulate the pain signals to lessen chronic pain. In some systems, the pulse generator is implanted whereas with other systems there is an external pulse generator. Improvements in ultrasonography and fluoroscopy now permit percutaneous implantation of the peripheral neurostimulator lead in direct vicinity of the stimulated nerve eliminating the need for a open surgical exposure of a peripheral nerve and direct implantation of the PNS electrode on the nerve itself.
Examples of peripheral stimulation indications with evidence of efficacy that may be covered by insurance are:
- PNS of occipital nerves for occipital neuralgia, post-surgical neuropathic pain, cervicogenic headaches and treatment resistant migraines.
- PNS of trigeminal nerves (and branches) for post-traumatic and post-surgical neuropathic pain in the face related to the trigeminal nerves.
- PNS of nerves in upper and lower extremities of complex regional pain syndromes (type 1 and 2), pain due to peripheral nerve injury, post-surgical scar formation, nerve entrapment, painful mononeuropathy, and painful amputation neuromas.
- PNS of intercostal and ilio-inguinal nerves for post-surgical and post-traumatic neuropathic pain involving these nerve distributions.
Peripheral Nerve Stimulator Options