Peripheral Nerve Stimulation: What Are the Current Indications and Which Patients Are Candidates?

Konstantin V. Slavin, MD

Associate Professor—Neurosurgery
Chief of Stereotactic and Functional Neurosurgery
Department of Neurosurgery
University of Illinois at Chicago Medical Center
Chicago, IL

Peripheral nerve stimulation is a neuromodulation technique in which electrical current is applied to peripheral nerves to treat various neuropathic pain conditions. Like spinal cord stimulation, the theoretical basis of peripheral nerve stimulation may reflect the gate-control theory of pain, wherein increased activity in large fibers can block nociceptive small-fiber signaling. It is used to treat chronic, severe pain that negatively affects the patient’s function, and is refractory to more common treatment approaches, including medications, physical therapy, and less invasive interventions. Patients are also usually required to meet two assessment criteria that are similar to those used for spinal cord stimulation: a psychological evaluation and a short-term trial with externalized electrodes. At the 2010 Annual Meeting of the American Academy of Pain Medicine, Dr. Slavin led a session on peripheral nerve stimulation and here answers questions on the theoretical basis of this modality; common indications, contraindications, and complications; general principles regarding how the surgery is performed; current evidence for outcomes; and future directions.

References

de Leon-Casasola OA. Spinal cord and peripheral nerve stimulation techniques for neuropathic pain. J Pain Symptom Manage. 2009;38(2 Suppl):S28-38.
Van Calenbergh F, Gybels J, Van Laere K, et al. Long term clinical outcome of peripheral nerve stimulation in patients with chronic peripheral neuropathic pain. Surg Neurol. 2009;72(4):330-335.
Slavin KV. Peripheral nerve stimulation for neuropathic pain. Neurotherapeutics. 2008;5(1):100-106

Would you like to comment? , or in if you are already a member.

Chronic opioid therapy and preventive services in rural primary care: an Oregon rural practice-based research network study.

Buckley DI, Calvert JF, Lapidus JA, et al.
Ann Fam Med. 2010;8(3):237-44.
PURPOSE:...

A different kind of co-morbidity: Understanding posttraumatic stress disorder and chronic pain

Beck JG, Clapp JD.
Psychol Trauma. 2011 Jun;3(2):101-108.
Many traumatic events leave...

The impact of enrollment in a specialized interdisciplinary neuropathic pain clinic

Garven A, Brady S, Wood S, Hatfield M, Bestard J, Korngut L, Toth C.
Pain Res Manag. 2011...

Association between urine drug test results and treatment outcome in high-risk chronic pain patients on opioids

Barth KS, Becker WC, Wiedemer NL, Mavandadi S, Oslin DW, Meghani SH, Gallagher RM.
J Addict...

The role of core strengthening for chronic low back pain.

Akuthota V, Standaert CJ, Chimes GP.
PM R. 2011 Jul;3(7):664-70.