Peripheral nerve stimulators for pain control

Peripheral nerve stimulation (PNS) is a useful method for managing chronic intractable neuropathic pain in the extremities. The technique is theorized to work by blocking the pain signals via the gate mechanism of pain. Patients should have completed nonoperative treatment including oral and topical medications, transcutaneous electrical nerve stimulation (TENS), unit trial, desensitization, and possibly a less invasive surgical procedure prior to being considered for PNS. PNS is considered as a first choice over spinal cord stimulation (SCS) when there is an isolated distal nerve injury or when SCS is contraindicated or refused by the patient. When SCS has failed to provide adequate coverage of the patient's pain as determined by the lack of paresthesia in the affected zone, or if the coverage is inconsistent, PNS is a reasonable second alternative. The surgery can be performed as a two-stage operation or as a one-stage operation with an intraoperative wake-up test. There are complications associated with an electrical implant in the body, including battery, wire, and electrode problems. Overall, with proper patient selection and good technique, the benefit of PNS outweighs the risks.