Peripheral Nerve Stimulation

Peripheral nerve stimulation delivers electrical pulses to a specific peripheral nerve that is causing pain.

Peripheral nerve stimulation is a type of neurostimulation. In this interventional pain management treatment, a permanent peripheral nerve stimulator is implanted under the skin. This device delivers regular electrical impulses to a specific peripheral nerve that is causing pain, blocking these pain messages before they can reach the brain. The peripheral nerve stimulator is small, like a pacemaker, and does not interfere with normal daily activities. Peripheral nerve stimulation therapy may help to reduce dependence on oral pain medications.

Peripheral nerve stimulation vs. peripheral field stimulation

Peripheral nerve stimulation and peripheral field stimulation are similar in that both procedures target nerves outside of the brain and spinal cord. However, they differ based on the approach to pain management:

• Peripheral nerve stimulation: Targets the major peripheral nerve that is located deeper in the body and which supplies the region in pain
• Peripheral field stimulation: Targets smaller nerve fibers located under the skin in the actual region that’s in pain

Conditions treated by peripheral nerve stimulation

Peripheral nerve stimulation is used in the treatment of:

• Peripheral neuropathy (nerve damage and pain), including diabetic neuropathy
• Complex regional pain syndrome (CRPS)
• Chronic headaches
• Occipital neuralgia (a condition that can cause severe headaches)

Your Henry Ford Pain Management specialist will work with you to determine whether a neurostimulation therapy (peripheral nerve stimulation, peripheral field stimulation or spinal cord stimulation) or other interventional pain management treatment is best for your pain condition.

Peripheral nerve stimulation is performed in two separate procedures

The two peripheral nerve stimulation procedures include:

1. Initial trial electrodes: An initial procedure to connect an external, trial pulse generator. This is used to test the effectiveness of the peripheral nerve stimulation treatment before proceeding to the permanent peripheral nerve stimulator.
2. Permanent peripheral nerve stimulator implant: If pain is reduced by 50 percent during the initial test period, you will undergo a second procedure to implant a permanent peripheral nerve stimulator under your skin for long-term pain management.

Procedure 1: Initial trial electrodes

During this minimally invasive procedure:

1. You lie on your stomach.
2. Your skin is sterilized at the injection site.
3. You will be administered a local anesthetic to numb the injection site.
4. Your pain management physician inserts wires (leads) through a needle, under your skin and into the area near the targeted peripheral nerve.
5. These leads are then connected externally to a smartphone-sized electrical pulse generator that you carry with you during the initial test period.

Procedure 2: Implanting the permanent peripheral nerve stimulator

This surgery is performed under general anesthesia. During this procedure:

1. You lie on your stomach.
2. Your skin is sterilized at the surgical site.
3. You are administered general anesthesia.
4. Your pain management physician connects the existing leads from the test pulse generator to a smaller peripheral nerve stimulator and implants this permanent device under your skin.

Following each peripheral nerve stimulation procedure

You will be moved to a recovery room and monitored by your care team. In most cases, peripheral nerve stimulation procedures are performed on an outpatient basis and you will go home the same day, although in rare cases some patients may require admission to the hospital following the procedure.

The Henry Ford Pain Center approach

At the Henry Ford Pain Center, pain treatment begins with a thorough medical history and physical exam. All patients are evaluated by board-certified pain medicine physicians, physician assistants and certified nurse practitioners to identify the cause of their pain. Following initial assessment, we work with you to develop a personalized treatment plan that may include interventional pain procedures, medication therapy, physical therapy, massage and other complementary options.