This is a minimally invasive technique to treat pain of peripheral nerve origin. Leads, small wires with multiple programmable electrodes are placed in the direct vicinity of a peripheral nerve. Unlike spinal cord stimulation, the leads are not placed within the spinal canal, making this an even less minimally invasive option.
Peripheral nerve stimulation can be used for pain emanating from any named peripheral nerve. Common problems that can be treated with peripheral nerve stimulation are occipital neuralgia (pain in the back of the head), chronic knee pain before or after knee surgery, chronic groin pain after hernia surgery, chronic chest wall pain after shingles or thoracic surgery, chronic shoulder pain before or after surgery, chronic back pain/buttock pain, as well as other chronic pain associated with peripheral nerves.
Peripheral nerve stimulation requires a successful nerve block and a successful trial. The benefit of a trial is the ability to experience the therapy without anything permanent being done. A small wire(lead) is placed through a needle to the specific location of a peripheral nerve. The lead is then tested to make sure the patient feels “buzzing” or “tingling” in the distribution of the nerve. If so, the lead is secured to the skin, with a suture and the patient is programmed. Over the course of 7-10 days different programs can be used. At the end of the trial the temporary lead(s) are removed. If the patient has substantial pain relief and improved function, they are a candidate for permanent implantation 10-14 days later.
Implantation requires placement of a new lead(s) which then connects to a very small, implanted generator, not much larger than a dime. The procedure can be done with one or more very small incisions. The implanted generator gets its power from an external battery that connects to the patient with an adhesive wearable clip. This clip keeps the battery in place and can be worn for up to three days before replacement. A patient can shower or swim with the clip on as long as the battery is removed. A patient will typically have a wear trial for the external battery before the actual trial to make sure wearing the external battery is comfortable and reasonable.