Peripheral nerve stimulation is a pain management technique that uses electrical impulses to disrupt pain signals as they travel through the nerves, relieving individuals who suffer from chronic pain.
If you’ve ever been hit in the funny bone, you can conclude that pain travels like a “jolt” through the body. Specifically, every sensation, feeling, and thought results from an electrical impulse, or series of impulses.
Our nervous system comprises billions of neurons, each resting or active. Think of it like 1s and 0s – this is how our body communicates voluntary and involuntary actions and sensations. Minerals called electrolytes like sodium and potassium are crucial for this task. It’s one of several reasons we need to replenish our minerals and fluids when we sweat a lot, or we might cramp.
This knowledge provides the foundation for many electrical therapies targeting muscle tissue and neurons. Physical therapists sometimes use electrical stimulation to help muscles on the road to physical recovery after an injury. Doctors also use peripheral nerve stimulation to assess a nerve’s function and neuromuscular transmission in paralyzed patients – i.e., to determine the degree to which a patient’s nerve function is impaired.
Similarly, pain specialists may utilize nerve stimulation to address malfunctioning nerves (neuropathy) or stop the pain. That’s how peripheral nerve stimulation was first invented.
What is Peripheral Nerve Stimulation?
Utilizing an electrical pulse to activate or deactivate a nerve at the right time could reduce or interrupt the transmission of pain signals. In the 1990s, this theory resulted in the development and use of specialized nerve stimulation devices to help address severe chronic pain. Peripheral nerve stimulation devices are called such because they typically target the peripheral nerves – i.e., your motor nerves, sensory nerves, and nerve roots.
However, there were a few drawbacks to these devices. They utilized a sizeable electric lead, which had to be implanted in the body, and led to the target nerve. They also involved cumbersome devices that would charge the lead and were thus both invasive and intrusive. Electrical stimulation for nerve pain became relegated to a form of per-session outpatient treatment or an outlier alternative to opioid and non-opioid pharmacology.
Until recently, the opioid epidemic has spurred medical technology and pharmaceutical companies to find alternative opioid medication for long-term pain management. While treating acute pain with opioids is one thing, chronic pain patients face a much greater risk of long-term side effects from opioid use. Furthermore, studies have shown that opioids become less useful for chronic pain the more prolonged the pain occurs, meaning better alternatives have always been needed. Medication management strategies have emerged as an effective way to minimize the risks associated with long-term opioid use.
Breakthroughs in nerve stimulation technology allow for the use of leads that are no thicker than human hair and entirely unintrusive, as well as much smaller, far less intrusive stimulator devices and innovative wireless activation rather than a continuous pulse.
Peripheral nerve stimulation is now available as a viable non-opioid alternative for chronic and acute pain in conditions such as neuropathic back pain, post-surgery shoulder pain, knee injuries, or diabetes-based foot pain.
How Does Peripheral Nerve Stimulation Impact Chronic Pain?
Newer peripheral nerve stimulation devices are a modality like many others, albeit more recently. But that should not be discouraging. Modern peripheral nerve stimulation devices have been thoroughly tested and vetted and have undergone rigorous testing with the FDA to receive official federal approval. Furthermore, the basis for this technology is decades old, and much of the older research still applies. These devices are smaller, safer, and more convenient now.
But as with any pain management tool, applicability is not universal. Not all chronic pain sufferers will benefit from using peripheral nerve stimulation devices.
Nevertheless, their efficacy is high: about 75 percent of chronic pain applicants benefitted from the implants, and over 50 percent reported long-lasting relief. Furthermore, adverse reactions – such as lead infections, continuous bleeding, or other serious issues – were infrequent.
As for how and why it works: a simple explanation requires us to go back to the fact that nerves exist to transport electrical signals throughout the body. All forms of electricity are positively or negatively charged. Stimulating a nerve directly allows us to activate it or cancel its activation. Targeted nerve pulses can result in direct pain reduction for acute and chronic pain, depending on the nature and cause of a patient’s pain.
Direct Stimulation for Managing Acute and Chronic Pain
Direct nerve stimulation – from an electrical lead to a target nerve, and not just via the skin through an electrode – can cancel the transmission of pain signals and provide a pleasant sensation in the target area. Some patients relate the feeling of a peripheral nerve stimulation device to a massage or pins and needles.
Peripheral nerve stimulation can be a long-term solution, but it is not typically permanent. For patients with acute postoperative pain – such as patients recovering from a joint replacement such as a total knee or hip arthroplasty – direct peripheral nerve stimulation can be an effective postoperative pain management tool. For patients with chronic neuropathic pain, such as diabetic neuropathy, peripheral nerve stimulation can be a great alternative to opioids.
Preparing for Peripheral Nerve Stimulation
How does a person insert an electrical lead the width of a human hair into the body? Via ultrasound, of course.
Peripheral nerve stimulation usually begins in an outpatient facility like a specialized pain clinic. A doctor disinfects and locally anesthetizes the initial injection site, then uses an x-ray or ultrasound imaging system to guide the lead through the body to the target nerve utilizing a special needle. Then, a transmitter is placed on or under the skin, and patients receive a wireless device – usually Bluetooth – to control the pulse.
Not all pain patients are ideal candidates for peripheral nerve stimulation. It’s usually more likely to be an option for you if:
- You are at a greater risk of developing problems with opioid medication or have had problems with opioids.
- Your pain is caused by peripheral neuropathy.
- You do not wish to have a more invasive procedure like surgery.
- Other more conservative methods – such as physical therapy – did not help.
- Your pain is not otherwise “easily” correctible.
Depending on the outcome of your treatment, the next step after a peripheral nerve stimulation may be to consider a nerve block.