Peripheral Nerve Stimulation- A New Tool For Managing Pain

Dr. Mark Matsunaga

Dr. Mark Matsunaga

A New Tool for Managing Pain

Anesthesiologist and pain specialist Mark Matsunaga, M.D. of The Comprehensive Pain Center, answers questions about a new treatment for chronic back pain called Peripheral Nerve Stimulation.


Q:  What is Peripheral Nerve Stimulation (PNS) and how does it work?

PNS is an evolving treatment modality for certain painful disorders. We use electricity to modulate the perception of pain. It uses vibrations to mask what the patient feels. The traditional neuromodulation technique was originally called Spinal Cord Stimulation (SCS). With SCS, the electrodes are placed in the spinal column directly over the spinal cord, and electrical stimulation is directed to certain areas of the spinal cord to produce a sensation in the brain that masks the pain. PNS places electrodes directly over peripheral nerves, and electrical stimulation is used to mask the nerve from delivering the pain stimulus to the brain. The implant can be programmed or controlled by a device that is placed over the battery. The battery is about the size of a silver dollar and is inserted under the skin and over the peripheral nerves. The procedure is performed under local anesthesia in an outpatient setting.


Q:  PNS has been available since the 1960s; what is new about this procedure today?

The technology advances are enormous. The size of the implant is much smaller. The ability to place the electrodes under the skin and the longevity of the battery (which can last 10 years) make the procedure very simple and noninvasive.


Q:  What types of pain does PNS address?

We treat neuropathic pain, meaning that it is the nerves that are causing the painful stimulation. The pain is usually described as a burning, electric or tingling sensation. PNS also can be helpful for other types of pain, including sharp, stabbing and aching sensations. We use PNS for low back pain from failed back syndrome, Facet disease, sacroiliac joint dysfunction, intercostal neuritis, post herpetic neuralgia, phantom limb pains, reflex sympathetic dystrophy and total joint replacement pain. The uses of PNS are basically limitless.


Q:  When should a patient consider PNS versus long-term drug therapy?

PNS is another option we now have in our toolbox to treat painful disorders. It can be used early in the disease process or later after all else has been unsuccessful. It is an individual decision. Some patients choose PNS because they do not want to be on narcotics. Other patients may choose it to avoid another surgical intervention. A trial stimulation period is done before placing the permanent system.


Q:  What does this treatment mean for a patient’s quality of life?

The success rate for lowering the reliance on narcotic or pharmacological management is very significant. More than 90 percent of individuals using this new technology say they would do it again.