Pain and Spine Advanced Clinical Focus Session: Has Peripheral Nerve Stimulation Finally Arrived?-Session Recording

Video Transcription

Video Summary

This panel discussion focuses on the evolution, evidence, applications, and practical considerations of peripheral nerve stimulation (PNS) as a neuromodulation therapy for pain management and other conditions. Dr. Desai presents the history of PNS, tracing it from early rudimentary uses to modern FDA-approved percutaneous devices, highlighting the transition from spinal cord stimulation tech repurposed for peripheral use to purpose-designed, less invasive PNS systems aided by ultrasound guidance. Clinical studies beginning around 2015 demonstrate increasing efficacy with responder rates now reaching over 80%, significantly improving outcomes in conditions like post-stroke shoulder pain, post-amputation pain, low back pain, and osteoarthritis.<br /><br />Dr. Kalia reviews the robust level 1 evidence supporting PNS efficacy and safety in neuropathic and nociceptive pain, as well as in non-pain indications such as bowel and bladder incontinence through sacral and posterior tibial nerve stimulation. He details specific clinical trial results showing significant improvements in pain scores, function, and quality of life with low adverse events, marking PNS as a viable and evolving therapeutic option.<br /><br />Dr. Vespoli and Dr. Raspoli contribute practical clinical insights via case studies involving challenging spinal and peripheral joint pain scenarios, including patients with complex comorbidities, emphasizing PNS’s minimally invasive nature, eligibility for insurance coverage, and favorable safety profile. They also discuss patient selection, shared decision-making versus radiofrequency ablation, and technical aspects of lead placement.<br /><br />A Q&A session addresses MRI compatibility (most devices are MRI-conditional with specific guidelines), the limited predictive value of diagnostic nerve blocks before PNS, device longevity (ranging from months to years), and choice of device based on patient and hardware factors.<br /><br />Overall, the discussion underscores that PNS is transitioning from a last-resort therapy to an earlier intervention with growing high-quality evidence, expanding clinical applications, and important considerations for personalized patient care and healthcare economics. It encourages clinician engagement, mentorship, and adoption of PNS to improve functional outcomes and reduce suffering in chronic pain populations.

Keywords

Peripheral Nerve Stimulation

Neuromodulation Therapy

Pain Management

FDA-approved Devices

Ultrasound Guidance

Clinical Efficacy

Neuropathic Pain

Non-pain Indications

Minimally Invasive Procedures

Patient Selection

Healthcare Economics