Peripheral nerve stimulation (PNS) for peripheral neuropathy pain

Overview

Peripheral neuropathy is damage to the nerves in the feet, legs or hands. It can cause burning, tingling, numbness or sharp, shooting pain. Diabetes is a common cause, but there are many others. Peripheral nerve stimulation, or PNS, places a very thin wire near a nerve in the leg. The wire sends mild electrical pulses that may change how pain signals reach the brain. PNS may help some people with neuropathy pain in a specific area. It is important to know that the research on PNS for neuropathy is more limited than for some other conditions, and results vary.

Watch: how peripheral nerve stimulation works

Video: “An Overview of SPRINT PNS” from SPR on YouTube. SPRINT PNS is one brand of peripheral nerve stimulation system, made by SPR Therapeutics. GSMC may recommend a different system based on your needs. It loads from youtube-nocookie.com only when you press play. Shown for general education; GSMC did not produce it. Watch on YouTube

What it is

In PNS, one or more thin leads (wires) are placed through a needle near a target nerve. For neuropathy pain in the foot or leg, this may be a nerve such as the tibial, sciatic or peroneal nerve. The leads connect to a small stimulator.

There are two general types of systems:

• Temporary systems: the lead is worn for a set time, often about 60 days, and then removed in the office.
• Long-term (implanted) systems: after a successful trial, a lead and a small device are placed under the skin and can stay in place long term.

Several companies make PNS systems. Our physicians choose a system based on your needs, and no brand can promise a result. PNS does not repair damaged nerves or treat the cause of neuropathy.

Symptoms and who it's for

Common neuropathy symptoms include:

• Burning, tingling or "pins and needles" in the feet or legs
• Numbness or a feeling of wearing socks when you are not
• Sharp, shooting or electric pain
• Pain that is often worse at night

PNS may be considered for some people whose nerve pain is in an area served by one or a few nerves and has not improved enough with medicines and other care. The evidence for PNS in peripheral neuropathy is more limited than for some other uses, such as certain knee, shoulder or back pain. For painful diabetic neuropathy, spinal cord stimulation has more research behind it, and our physicians may suggest it instead.

What the procedure involves, step by step

1. Before: we review your history, exam, any nerve tests and your neuropathy cause. A test nerve block may help show whether a specific nerve carries your pain. Some medicines, such as blood thinners, may need to be paused with approval from the prescribing doctor.
2. Placement: in an outpatient visit, the skin is numbed. Using ultrasound or X-ray guidance, your physician places one or more thin leads through a needle near the target nerve.
3. Setup: the lead connects to a small stimulator. Your care team adjusts the settings to cover your pain area.
4. Use at home: you use the stimulator during daily life and track your pain, sleep and activity.
5. Follow-up: with a temporary system, the lead is removed in the office at the end of the treatment period. If a long-term system is chosen, it is placed in a separate procedure.

Recovery and what to expect

• Most people go home the same day and return to light activity within a day or two.
• Keep the lead site clean and dry. People with diabetes or poor feeling in the feet should check their skin daily.
• Some people notice a change in pain during treatment. Many others do not, and it is hard to predict who will improve.
• Keep caring for your neuropathy: blood sugar control, foot care and regular check-ups remain important.

Candidacy: who may or may not be a good fit

May be a good fit: some people with neuropathy pain in a limited area, served by a specific nerve, that has not improved enough with medicines and other care, and who understand that the research is still limited.

May not be a good fit: people with widespread neuropathy pain in both legs and feet (spinal cord stimulation may fit better), poor wound healing, foot ulcers or infection near the site, poorly controlled diabetes, a bleeding problem, certain implanted heart devices, or skin problems that limit adhesive use. The cause of neuropathy should be checked first, because some causes can be treated directly.

Risks in brief

Risks include skin irritation, infection at the lead site (a greater concern for people with diabetes or poor circulation), bleeding or bruising, and the lead moving or breaking. Small lead fragments can, rarely, remain under the skin. Pain may not improve. We will review your specific risks.

Alternatives

Other options may include treating the cause of neuropathy, medicines for nerve pain, topical treatments, physical therapy, foot care and, for some people with painful diabetic neuropathy, spinal cord stimulation.

Frequently asked questions

Insurance

GSMC participates with all Aetna plans, including Aetna HMO, and with many other insurance plans. Coverage for a specific procedure depends on your plan and may need prior authorization; call 732-202-3000 to verify. Our team can help check your benefits before treatment.

See accepted insurance

Related pages

Related conditions

• Neuropathic (nerve) pain
• Foot pain
• Leg pain

Related treatments and resources

• Peripheral nerve stimulation (overview)
• Spinal cord stimulation
• PNS for knee pain
• PNS for shoulder pain
• Nalu peripheral nerve stimulation