Peripheral Nerve Stimulation

Recently, Peripheral nerve stimulation (PNS) has become an alternative to treating patients with various neuropathic (nerve) pain syndromes who do not respond to more conventional interventions. Usually, these are patients who have failed to respond to medications, physical therapy, acupuncture and nerve blocks. This novel method uses placement of spinal cord stimulator leads into the subcutaneous (superficial) painful area of the body. A variety of neuropathic pain syndromes can be treated with this method, including: abdominal pain, inguinal neuropathy, daily migraine headache, occipital neuralgia and fibromyalgia.

The mechanism of pain relief for patients undergoing PNS remains elusive, despite some prevailing theories : increased local blood flow, increased serotonin and dopamine at the spinal cord level, and inhibition of specific nerve cells called wide-dynamic-range neurons.

Similar to the spinal cord stimulation cases, these patients undergo an initial trial for 1-2 weeks and if the pain is reduced by more than 50% during the trial period, the patient becomes eligible for the implantation of the device. The implantation itself is done on an outpatient basis and both the lead(s) and the battery are tunneled under the skin. The above figure shows the picture of two leads implanted under the skin of the lower occipital area for patients suffering from intractable migraine headaches.