Peripheral nerve stimulation
- Indicated
- Refractory severe chronic,
- Focal neuropathic pain
- Post-traumatic neuropathy,
- Complex regional pain syndromes,
- Post-herpetic neuralgia affecting 1 or 2 dermatomes
- Technique
- Placement of a stimulating electrode over a named peripheral nerve to elicit paresthesias along the innervated territory (e.g. occipital, supraorbital, infraorbital, radial, ulnar, median, tibial, peroneal, and sciatic nerves).
Peripheral nerve field stimulation (PNfS)
- Aka
- Subcutaneous neurostimulation
- Targeted subcutaneous stimulation
- Technique
- Involves positioning of one or more electrodes within the region of maximal pain, where small distal branches of nerves are targeted within the subcutaneous space.
- Field stimulation produces paresthesias along a diffuse painful area that may not correlate with one specific peripheral nerve territory.
- Body regions rather than nerves are used to describe the PNfS (e.g. low back, trunk, joint).
- “Hybrid” stimulation
- Aka
- Spinal-peripheral neurostimulation
- Triangular stimulation.
- = Spinal cord stimulation (SCS) + PNfS
- Shown to achieve broader coverage of axial back pain than either SCS or PNfS individually.
- Complications
- Infection,
- Lead erosion,
- Migration of the lead,
- Mechanical issues with the device.
- Pain at the site of the generator or lead site occurs in some patients.
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