What is Peripheral Nerve Stimulation?
Peripheral nerve stimulation is a minimally invasive treatment for chronic pain and pain caused due to peripheral nerve damage. The peripheral nerves connect your brain and spinal cord with the rest of the body. Pain arises from the signals produced by a nerve when it is stimulated by tissue damage or when the nerve itself is damaged (neuropathic pain). Peripheral nerve stimulation involves stimulation of the affected nerves using electrical impulses generated by a device implanted in your body. This interrupts the transmission of pain signals so that, instead of pain, you experience a mild tingling.
Indications for Peripheral Nerve Stimulation
Peripheral nerve stimulation is mainly used to treat chronic and neuropathic pain. It can be used to treat pain associated with a wide range of conditions such as:
- Nerve damage due to injury or surgery
- Multiple sclerosis
- Heart disease (angina)
- Complex regional pain syndrome
- Occipital neuralgia
- Chronic back pain
- Intercostal neuralgia
- Diabetic peripheral neuropathy
- Post amputation pain
Peripheral nerve stimulation is sometimes also used to treat other conditions besides pain.
These include overactive bladder, urinary urgency, depression, and obesity.
Preparation for Peripheral Nerve Stimulation
To prepare for peripheral nerve stimulation:
- Your doctor will perform a neuropsychological examination and provide you with some pain charts to get a better understanding of your pain and to plan the procedure. The charts include a pain diary which should be filled out over a week.
- Inform your doctor if you:
- Are or might be pregnant
- Have had any previous health conditions
- Are taking any blood-thinning medications such as aspirin
- Are allergic to any medications or anesthesia
- Do not stop taking your regular medications until instructed by your doctor
- Arrange for someone to drive you home
Procedure for Peripheral Nerve Stimulation
The procedure for peripheral nerve stimulation is performed in 2 steps that include:
- This is a trial procedure that begins with the insertion of electrodes.
- You will be instructed to lie on the observation table and anesthesia will be injected to make the site of insertion numb.
- A small incision will be made and the target nerves will be located.
- Through the incision, the electrodes are inserted and fixed along the targeted nerves
- The electrode wires are connected to an external stimulator which you can control to produce the impulses.
- Following insertion of the electrodes, you will be kept under observation in the recovery room and can return home the same day.
- The trial lasts for about a week and if you have significant pain relief and are happy with the results, the second step is performed. The trial also helps your doctor determine the right amount of stimulation for ideal pain relief
- This step will be performed a few days or weeks after a successful trial.
- During this procedure, anesthesia will be administered and the temporary external wires will be removed.
- Wires running under the skin are attached from the electrodes to a battery-operated internal stimulator implanted under your skin and programmed to deliver the determined level of stimulation. The internal stimulator is usually placed in the upper buttock, chest wall, or under the arm.
Post-operative Care and Recovery for Peripheral Nerve Stimulation
After the peripheral nerve stimulation procedure, you will be kept under observation for a few hours and can then go back home. On discharge, you will receive aftercare instructions and will be informed about certain restrictions such as avoiding metal detectors at airports. Your incision site should be kept dry and should heal within two weeks at which time you will have a follow-up appointment. Avoid strenuous activity for at least 6 weeks.
Risks and Complications of Peripheral Nerve Stimulation
As with any procedure, there may be certain risks and complications associated with peripheral nerve stimulation which include:
- Nerve damage
- Scar tissue formation
- Muscle cramps
- Malfunctioning of the stimulator or damage to the leads