Birds of a Feather Redux: Defining Ways to Stimulate the Peripheral Nervous System

Abstract

Peripheral nerve stimulation (PNS) has become an essential component in the pain management plan for individuals suffering from peripheral nerve-mediated pain. The recent surge in interest in PNS can be attributed to the advancements in imaging techniques and the availability of minimally invasive stimulation systems along with a deeper grasp of PNS physiology. These advancements have made PNS more accessible to clinicians and patients alike. However, it is important to note that PNS requires a different set of technical requirements and skills compared to other pain management procedures. The work, knowledge, and surgical and interventional skillset required for PNS are in a class of their own. This article aims to educate and clarify the differences between procedures that may have similar names but are vastly different in terms of technology, expertise, and skill sets necessary for their safe implementation. Some of the procedures that this article will cover include indirect peripheral nerve field stimulation (PNfS), indirect percutaneous electrical nerve stimulation (PENS), PENS-Field Stimulation (PENFS), and transcutaneous electrical nerve stimulation (TENS). By understanding the differences between these procedures, patients and health-care providers can make informed decisions about the best approach for managing pain.

Keywords:

• peripheral nerve stimulation
• neuromodulation
• minimally invasive stimulation systems

Disclosure

TD: Consultant to SPR, Nalu, Mainstay, during the conduct of the study. Consultant to Abbott, Saluda, Painteq, Spinal Simplicity, Ethos, Vertos, Medtronic, Boston Scientific, Tisue Tech; Funded Research: Boston Scientific, Abbott, SPR, Mainstay Minor equity: Ethos, Spinthera, Cornorloc, Painteq, Spinal Simplicity, Saluda, Vertos, outside the submitted work. KS reports institutional grants and consulting income from Medtronic, Abbott, Boston Scientific, Neuros, Integer, Biotronik, Saluda and WISE, and minor ownership of Neuramodix, Thermaquil, Vycor Medical and Higgs Boson. SS: Consultant to Allergan, Inc, Masimo Corp, SPR Therapeutics. WPM: Consultant to Nalu, SPR, Nalu Minor Equity. ML: Consultant to Sorrento Therapeutics and Wex Pharmaceuticals. The authors report no other conflicts of interest in this work.