What is peripheral nerve stimulation?
Peripheral Nerve Stimulation is a form of neuromodulation designed to target a specific peripheral nerve that is contributing to a patient’s pain.
Unlike a spinal cord stimulator, which delivers stimulation near the spinal cord, a PNS system places a small lead beneath the skin near the peripheral nerve responsible for your symptoms. The lead delivers carefully controlled electrical stimulation that interacts with the nerve’s pain signaling, helping modify how pain signals are transmitted and processed.
Because PNS targets a specific peripheral nerve, it provides a highly localized approach to treating certain types of chronic pain.
A small implanted lead — an external generator
One of the most common questions patients have is whether a battery or generator will be permanently implanted in their body. With the PNS system Dr. Shamloo uses, only the small stimulation lead is implanted beneath the skin. The generator remains completely outside the body.
The lead is positioned near the targeted nerve and communicates wirelessly via Bluetooth with a small external generator, worn in a specially designed wearable pouch. There is no implanted battery or generator near the painful knee, shoulder, hip, ankle, or other treatment area.
This allows patients to receive targeted nerve stimulation without having a bulky generator implanted beneath the skin.
What conditions can PNS treat?
PNS may be considered for a variety of chronic pain conditions when a specific peripheral nerve is contributing to symptoms. Depending on the individual patient, it may be used for:
PNS is not appropriate for every type of pain. The treatment is most useful when the pain can be associated with a specific peripheral nerve or group of nerves.
How does PNS work?
PNS begins with identifying the nerve that is contributing to your pain. Depending on the location, ultrasound or other imaging guidance may be used to precisely identify the target nerve and safely position the stimulation lead.
A small lead is placed beneath the skin near — not directly inside — the targeted peripheral nerve, and delivers controlled electrical stimulation designed to modulate the nerve’s pain signaling. The implanted lead communicates wirelessly with the external generator, allowing settings to be adjusted based on your needs and response.
The PNS trial
For appropriately selected patients, PNS may begin with a temporary trial. A temporary stimulation lead is positioned beneath the skin near the targeted nerve and connected wirelessly via Bluetooth to a small external generator worn in a specially designed pouch.
This allows you to move about while experiencing the treatment in your normal environment, and to determine whether PNS provides meaningful improvement in pain and function before deciding whether to continue with longer-term treatment.
The exact trial and treatment approach can vary depending on the PNS system being used and your individual condition.
Potential benefits
For appropriately selected patients, peripheral nerve stimulation may:
PNS does not necessarily eliminate the underlying condition causing pain. The goal is to reduce pain signaling and help patients function more comfortably.
PNS for peripheral neuropathy
Peripheral neuropathy can cause chronic burning, tingling, stabbing, electric, or shooting pain, most commonly affecting the feet and legs but sometimes involving the hands and arms. When neuropathic pain is severe or persistent despite conventional treatment, neuromodulation may provide another option.
Dr. Shamloo has extensive experience using peripheral nerve stimulation for appropriately selected patients with peripheral neuropathy and other forms of chronic nerve pain. Because PNS targets peripheral nerves, it can provide a more localized neuromodulation approach for certain patterns of neuropathic pain.
PNS for joint & extremity pain
Not all joint pain comes directly from the joint itself. In some patients, persistent pain following an injury, surgery, or chronic joint condition may involve irritation or dysfunction of the nerves surrounding the affected area.
When a specific peripheral nerve is identified as an important contributor, PNS may be considered as part of a comprehensive treatment plan — including for chronic pain involving the knee, shoulder, hip, elbow, wrist, ankle, foot, or hand.
Dr. Shamloo also works closely with orthopedic extremity specialists when appropriate, helping patients receive comprehensive care when their condition requires both orthopedic and interventional pain expertise.
How is PNS different from spinal cord stimulation?
Both use neuromodulation to alter pain signaling, but they target different areas of the nervous system.
Peripheral nerve stimulation targets a specific peripheral nerve, and is best suited to localized nerve-related pain affecting an extremity, joint, or other specific area. Spinal cord stimulation targets the spinal cord, and is best suited to broader patterns of chronic neuropathic pain — including certain types of persistent spinal pain, leg pain, and pain following spine surgery.
The location and cause of your pain help determine which form of neuromodulation may be most appropriate.