Peripheral Nerve Stimulator

What is a Peripheral Nerve Stimulator?

A peripheral nerve stimulator is a medical device designed to alleviate chronic pain by delivering electrical impulses to specific nerves in the body. It typically consists of small electrodes that are placed near the nerves responsible for transmitting pain signals. 

These electrodes are connected to a generator, which produces the electrical impulses. When activated, the stimulator sends these impulses to the nerves, disrupting the transmission of pain signals to the brain and providing relief from discomfort.

How Does Peripheral Nerve Stimulation Alleviate Chronic Pain?

Peripheral nerve stimulation (PNS) alleviates chronic pain by interrupting or modulating the transmission of pain signals along the nerves.

 Here’s a breakdown of how peripheral nerve stimulators work:

• Electrode Placement. Small electrodes are surgically implanted near the targeted peripheral nerves responsible for transmitting pain signals.
• Electrical Stimulation. Once the electrodes are in place, they deliver low-level electrical impulses to these nerves.
• Interference with Pain Signals. The electrical impulses interfere with the normal transmission of pain signals along the nerves. They can either block the pain signals from reaching the brain or modify them in a way that reduces their intensity.
• Activation Control. Patients can usually control the stimulation intensity and timing using an external device. This allows them to adjust the therapy according to their pain levels and comfort.
• Neuromodulation. By modulating the activity of the nerves, PNS can induce changes in the nervous system that contribute to pain relief over time.
• Gate Control Theory. PNS may also operate on the principle of gate control theory, which suggests that stimulating certain nerve fibres can override or block pain signals from reaching the brain.

Overall, peripheral nerve stimulation offers a minimally invasive method for managing chronic pain, providing relief and improving the quality of life for many patients.

Why Would You Get a Peripheral Nerve Stimulator  for Chronic Pain?

Peripheral nerve stimulation (PNS) or a peripheral nerve stimulator implant may be recommended for chronic pain when other treatments have not provided sufficient relief or when the side effects of other treatments are intolerable. 

Here are some reasons why you might consider getting a peripheral nerve stimulator for chronic pain:

• Failed Conventional Treatments. If traditional methods such as medication, physical therapy, or surgery have not effectively managed your chronic pain, PNS may be considered as an alternative or adjunctive treatment.
• Reduced Side Effects. Compared to systemic medications, PNS offers localised pain relief with potentially fewer systemic side effects, making it an attractive option for those who cannot tolerate or wish to avoid medications.
• Preservation of Functionality. Peripheral nerve stimulators can help you maintain or regain functionality and mobility by reducing pain, allowing them to participate in daily activities and improving their quality of life.
• Minimally Invasive. PNS procedures are minimally invasive compared to some surgical interventions, reducing the risks associated with more invasive procedures.
• Customisable Therapy. PNS therapy can be customised to suit individual needs, allowing you to adjust stimulation parameters based on their pain levels and preferences.
• Reversibility. Unlike surgery, the PNS device is completely reversible and can be removed at any stage if required.
• Long-Term Pain Management. PNS may provide long-term pain relief for certain chronic conditions, reducing the need for frequent medication adjustments or invasive procedures.
• Specific Pain Conditions. PNS may be particularly beneficial for certain types of chronic pain, such as peripheral neuropathic pain, occipital neuralgia and chronic migraines.

Ultimately, the decision to pursue peripheral nerve stimulation for chronic pain should be made in consultation with a doctor who can assess your specific condition, medical history, and treatment goals.

The Risks of Peripheral Nerve Stimulation 

While peripheral nerve stimulation (PNS) is generally considered safe and effective for managing chronic pain, like any medical procedure, it carries certain risks. 

Some potential risks and complications associated with getting peripheral nerve stimulator device implanted  include:

• Infection. Any surgical procedure carries a risk of infection at the site of implantation. Proper sterile technique during the implantation procedure and diligent postoperative care can help minimise this risk.
• Bleeding. There is a possibility of bleeding at the site of implantation, particularly during the surgical procedure. This risk is usually managed by the doctor using appropriate techniques and monitoring.
• Lead Migration. The electrodes or leads used in your PNS device may move from their original placement over time, potentially reducing the effectiveness of stimulation or causing discomfort. Proper placement and securing of the leads can help mitigate this risk.
• Hardware Malfunction. Components of the peripheral nerve stimulator device, such as the generator or leads, may malfunction or fail over time. This can result in inadequate pain relief or the need for additional procedures to repair or replace the device.
• Stimulation-Related Side Effects. In some cases, the electrical stimulation provided by the device may cause unwanted sensations or discomfort, such as tingling, numbness, or muscle twitching. Adjusting the stimulation parameters can often alleviate these side effects.
• Allergic Reaction. Some individuals may experience an allergic reaction to the materials used in the device or the surgical implantation procedure. This risk is relatively low but should be considered for those with known allergies.
• Scar Tissue Formation. Scar tissue may form around the implanted electrodes or leads, potentially interfering with the effectiveness of stimulation or causing discomfort. Regular follow-up appointments with your doctor can help monitor for any signs of complications.
• Psychological Effects. Adjusting to life with a peripheral nerve stimulator can have psychological implications, including feelings of dependency on the device or frustration if pain relief expectations are not met.
• Failure. There are some rare situations when a patient will experience positive benefit from the trial but is unable to achieve a significant benefit from the permanent implant. In these instances, an attempt at programming is made for 6 months and if there is no success, the implant is removed. 
• Technical difficulty. The procedure may not be possible due to medical or technical reasons and may need to be abandoned. 
• X-ray exposure. There may be an increased lifetime risk of cancer due to repetitive exposure to X-rays – this is very rare.

If you are considering peripheral nerve stimulation for chronic pain management, it is essential to discuss the potential risks and benefits with your doctor. This allows for informed decision-making and appropriate management of any complications that may arise.

The Process of Getting a Peripheral Nerve Stimulator

At the Persistent Pain Solutions clinic, the procedure for peripheral nerve stimulation (PNS) is conducted in two stages.

During the first stage, electrodes are surgically implanted along the target nerves, with the ends of the wires exposed above the skin. These electrodes are then connected to a portable stimulation device for approximately 10-14 days following the procedure. During this time, the effectiveness of the stimulator in reducing pain levels is assessed. After 14 days, the electrodes are removed in clinic by your pain physician and this concludes the trial.

If the stimulator demonstrates significant pain reduction during the trial period, the second stage involves the permanent insertion of the electrodes and a miniature stimulator equipped with an internal battery under the skin. 

This permanent implantation is typically done in the chest, back, or abdominal cavity. The implanted device is designed to provide ongoing pain relief, with rechargeable batteries that can be replenished or recharged without the need for removal. Depending on the setting of the stimulator, the batteries generally have a lifespan of five to 10 years.

Preparing for a Peripheral Nerve Stimulator

Prior to getting a PNS procedure at the Persistent Pain Solutions clinic, we will provide you with a pain chart and a pain diary to complete over a seven day period. The pain chart helps identify the areas of your body affected by pain, while the pain diary records pain levels and any changes observed each day. Additionally, a brief survey will prompt you to describe the type of pain you experience in a few words.

For optimal preparation, please abstain from undergoing any other medical procedures, such as dental treatments or colonoscopies, within 48 hours before or after the procedure.

Prior to the procedure, refrain from eating or drinking for 6-8 hours (although medication can be taken with small sips of water). You are required to stop smoking 6 weeks before the surgery. You will be provided with a full body antiseptic wash to be applied for a few days before the surgery to minimise the risk of infection.

Please inform us in advance if you have any allergies, a history of high blood pressure, bleeding or blood clotting issues (such as DVT or pulmonary emboli), a pacemaker or defibrillator, are taking antibiotics, or are feeling unwell. 

Please inform the team if you are taking medications for diabetes, blood thinning medications or weight loss medications. You will be provided instructions on management of these medications by Dr Mittal before the surgery. 

Furthermore, arrange transportation to and from the appointment as you should not drive yourself due to the sedation involved.

After Getting a Peripheral Nerve Stimulator  (Follow-Up) 

After getting a peripheral nerve stimulator implanted, you may experience some discomfort at the insertion site for approximately one week. During this period, it is important to refrain from lifting heavy objects and avoid excessive stretching, twisting, or bending beyond 45 degrees to prevent aggravating the area.

The dressing covering the incision must be kept dry to promote proper healing. You will also undergo frequent checks to monitor for any signs of infection at the insertion site, ensuring optimal recovery and safety.

Additional Issues to Consider with a Peripheral Nerve Stimulator Implant.

• MRI compatibility. Peripheral nerve stimulators are generally MRI conditional. This means that most patients can obtain MRIs after the device is placed at a specific radiology clinic which has experience with such devices. You can contact your medical device representative or Dr Mittal for recommendation of a suitable radiology clinic that can perform the MRI. Rarely, the device needs to be removed to obtain specific forms of MRI images depending on the underlying pathology. (for eg, MRIs for brain aneurysms). 
• Recharging of the device. There are two types of batteries that may be used: Rechargeable or Non-rechargeable. The rechargeable batteries will require regular recharging either daily, every few days or weekly depending on the energy consumption. 
• Battery change. The IPG battery will require changing every 5-10 years depending on the energy consumption. This is usually a day case procedure performed under sedation anaesthesia.
• Driving. During the trial phase, you are not allowed to drive. After the permanent implantation, driving may be commenced only 6 weeks after the surgery. There are stimulation programs that may need to be turned off whilst driving (for eg: tonic stimulation). This is accommodated with other programs that can be used whilst driving instead.
• Travel. Dr Mittal does not recommend travel for the first 3-4 months after the procedure to allow for monitoring and programming of the device. When resuming travel, you will be provided with a ‘device card’ since the device will often ‘beep’ when moving through a metal detector at the airport.
• Exercise. During the trial period, you are restricted from certain movements such as raising arms above shoulder height, heavy lifting and forward bending. This is to avoid migration of the electrode leads. After the permanent implant, you are strongly recommended to follow the same restrictions for 3 months after the implant to allow for enough scar formation to prevent lead migration. During the first 3 months, you are allowed to walk on a regular basis for exercise. After three months, you may commence physiotherapy, hydrotherapy and weight training. 
• Swimming. You are recommended not to engage in swimming or utilise a public pool or spa during the trial period. This is to minimise the risk of infection. After the permanent implant, these restrictions continue for the first 3 months after the procedure. Following this, you may recommence swimming and hydrotherapy. 
• Activity. Once the device is working well and you are beyond the three month period, you may engage in any form of activity (such as running, jogging, walking, bike riding, weight training, swimming). However some activities are best avoided to prevent lead migration or fracture – these include high impact sports like playing footy, bungee jumping or scuba diving. 

Getting a Peripheral Stimulator Removed

If you do not experience a significant reduction in pain after getting a peripheral nerve stimulator, it can be removed in a short procedure.

However, if a peripheral nerve stimulator (PNS) does not provide the expected relief or fails to work adequately, several steps can be taken to address the situation:

• Reevaluation. The first step is to reassess the placement and settings of the stimulator. Sometimes, adjusting the stimulation parameters or repositioning the electrodes may improve its effectiveness.
• Trial of Different Settings. Different stimulation settings can be tried to determine if alternative configurations provide better pain relief.
• Revision Surgery. In some cases, revision surgery may be necessary to reposition the electrodes, replace malfunctioning components, or address any issues contributing to the lack of efficacy.
• Alternative Treatments. If peripheral nerve stimulation does not provide satisfactory pain relief, alternative pain management strategies may be explored. This could include trying different medications, physical therapy, cognitive-behavioural therapy, or other interventional procedures.
• Exploring Other Modalities. If peripheral nerve stimulation is not effective, other neuromodulation techniques such as spinal cord stimulation or dorsal root ganglion stimulation may be considered.
• Managing Expectations. It’s important for patients and their doctors to communicate openly about expectations and goals for pain management. Sometimes, realistic expectations may need to be adjusted based on individual circumstances and response to treatment.

Finding a Doctor Who Performs Peripheral Nerve Stimulation  Near You

Finding a doctor who performs peripheral nerve stimulation in Melbourne or elsewhere in Australia is a key first step towards reducing or managing your chronic pain condition. 

Consult your general practitioner to get a referral to a pain management physician who offers peripheral stimulators or similar procedures for chronic pain. You can also research pain management clinics online or speak to family members, friends, or support groups (both online and in real life) for recommendations from those who have dealt with similar chronic pain issues.

Peripheral Nerve Stimulation at Persistent Pain Solutions

Persistent Pain Solutions is a pain management clinic in Melbourne, Australia that provides peripheral nerve stimulators and related treatments to chronic pain patients who wish to avoid surgical interventions or more invasive procedures.

If you have a chronic pain condition that is not responding to other treatments, reach out to the team at Persistent Pain Solutions. Dr. Mittal and her team will help you determine if getting a peripheral nerve stimulator can offer you relief and otherwise help create a pain management plan that enables you to live a fuller, more complete life.