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Is Peripheral Stimulation Right for You?
Peripheral nerve stimulation, frequently referred to as PNS, is a commonly used approach to treat chronic pain. It involves surgery that places a small electrical device (a wire-like electrode) next to one of the peripheral nerves. (These are the nerves that are located beyond the brain or spinal cord). The electrode delivers rapid electrical pulses that are felt like mild tingles (so-called paresthesias).
During the testing period (trial), the electrode is connected to an external device, and if the trial is successful, a small generator gets implanted into the patient’s body. Similar to heart pacemakers, electricity is delivered from the generator to the nerve or nerves using one or several electrodes. The patient is able to control stimulation by turning the device on and off and adjusting stimulation parameters as needed.
PNS was invented in the mid-1960s, even before the commonly used spinal cord stimulation. Starting in 2012, a number of therapeutic devices that stimulate peripheral nerves or that provide peripheral nerve field stimulation received regulatory approval in a number of regions around the world for treatment of neuropathic pain and, in some geographic areas, for treatment of migraine headaches and overactive bladder.
Some peripheral neurostimulation devices share technical similarities with methods developed and used for vagus nerve stimulation (widely used for treatment of epilepsy and depression), phrenic nerve stimulation (used for respiratory insufficiency due to impairment of diaphragmic control), and sacral nerve stimulation (approved for treatment of urinary incontinence and used for variety of bladder conditions).
A small external pulse generator that is wearable and low profile. This generator is what produces your electrical medication.
Thin insulated wire that carries the electrical stimulation from the pulse generator to your targeted peripheral nerves.
A handheld “remote control” that allows you to adjust your stimulation settings within the limits set by your physician.
A Peripheral Nerve Stimulator System (PNS) utilizes similar technology to a spinal cord stimulator system. A neurostimulator with electrodes and a receiver, that utilizes wireless RF power, is placed near a peripheral nerve in your body, below the head, to treat your chronic pain. Fitting through a needle sized incision allows for placement with minimally invasive surgery, typically as an outpatient procedure.
Before the device is implanted permanently, there is typically a trial period to determine if the therapy is effective for your chronic pain. PNS is covered by most insurance plans.
When discussing and planning the procedure with your doctor, be sure to confirm your insurance coverage of the procedure and any required hospital stay well in advance.
Tell your doctor about the medications you’re taking, about your allergies, and about any surgeries you have had, as well as any reactions to anesthesia in the past.
Arrange to have someone accompany you to the hospital on the day of the procedure, and to have someone drive you home afterward. You may also need to have a friend or family member help you at home for a day or two after the surgery.
Before your surgery, your doctor will determine the most suitable spot in your abdomen for the pump in an effort to not interfere with clothing or daily activities.
Your doctor and the hospital will give you important instructions to follow before the surgery. Follow these pre-surgery instructions carefully.
In most cases:
On the day of the procedure:
Before placing a permanent implant, you and your care team will go through a trial run to ensure the implant will produce the desired results. Typically, a trial lasts 3-7 days, giving you time to evaluate if this therapy is right for you. If this proves successful, a permanent implant will be provided. The PNS device is small enough that it can be placed under the skin. You will be provided with a remote that can turn the device on or off as needed.
When pain flares up, the device works by sending mild electrical signals out to interrupt the nerve signals. While some patients have been apprehensive at the thought of having electrical signals being released, many have had this procedure and achieved the results they needed.
PNS has a very high success rate and the results are almost immediate. In the rare case that the device isn’t working correctly and needs to be removed, this can be done very easily. The implant is placed just beneath the skin, making implantation and removal a minimally invasive process.
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