Peripheral Nerve Stimulation as a Treatment for Joint Pain
Peripheral nerve stimulation is a common non-pharmaceutical treatment for chronic pain. It can help with a variety of conditions, especially those involving nerve pain. It can be used to treat arthritis too.
This article explains the pros and cons of peripheral nerve stimulation, the treatment process, side effects and more. Here’s all you need to know.
What is Peripheral Nerve Stimulation?
The peripheral nerves exist outside the brain and spinal cord, such as those in the arms and legs. Peripheral nerve stimulation (PNS) targets these nerves to block pain signals and relieve a variety of uncomfortable conditions.
The treatment is also sometimes known as neuromodulation. It involves implanting a small electrode under the skin, close to one of the peripheral nerves. This electrode is connected to a generator battery, which transmits rapid electrical pulses to the area.
It is still unclear precisely how PNS works. However, most experts believe it prevents pain signals from reaching the brain by providing an alternative stimulus. This is known as the gate control theory of pain.
PNS is most frequently used to treat neuropathic (nerve) pain. Some doctors also recommend it for migraines and headache disorders, overactive bladder syndrome, fibromyalgia and more.
It is less commonly used to treat other painful conditions, such as arthritis. However, it may be useful for postoperative pain, such as following a knee replacement. There is also some evidence that PNS could help to relieve chronic joint pain, although further study is required.
PNS is usually recommended if a patient has failed to respond to conventional treatments like painkillers and physical therapy.
Pros and Cons of Peripheral Nerve Stimulation
The main advantage of PNS is that it is non-pharmaceutical.
In recent years, people have become increasingly reluctant to take painkillers such as opioids, which can be addictive and potentially dangerous. Furthermore, neuropathic pain is notoriously difficult to treat with medication. PNS may offer some hope for patients who have found other treatments ineffective.
The main disadvantage is that PNS does not work for everyone. Furthermore, it is unsuitable for some groups of people, including people with heart problems, epilepsy and pregnant women.
There are also some minor risks associated with the procedure, which we discuss below.
Pros:
- Reduces the need for opioids and other medication.
- Can be helpful if other treatments for arthritis have failed.
- It’s generally safe with minimal risks.
Cons:
- The effectiveness can depend on the person, as everyone is different.
- Since it requires surgery, there are post-operative risks.
- It may not be suitable for all patient groups.
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Does Peripheral Nerve Stimulation Work?
Like most medical treatments, PNS does not work for everyone. Therefore, it is common practice for patients to undertake a trial period to gauge its effectiveness. This involves connecting the implanted electrode to an external generator for several days.
If the trial is successful, the patient can proceed and have a generator implanted under their skin.
Peripheral Nerve Stimulation Treatment Process
During the procedure, the surgical team will use a local anesthetic to numb the area where the electrode will be implanted. They might also use a sedative to help the patient relax.
The electrode is implanted via a needle, using an ultrasound to guide it into place. It is then connected to the generator with fine wires. The generator is usually placed in the patient’s abdomen, chest, buttock, or thigh.
Some newer PNS devices operate wirelessly, connecting to a generator outside the body. This can be worn on a belt or piece of jewelry.
Peripheral Nerve Stimulation Side Effects
As with any surgical procedure, PNS is associated with certain risks. The most common of these are bleeding, bruising, or infections. The patient may also experience pain during or after the surgery, and doctors can prescribe painkillers to help relieve this side effect.
In some cases, the surgery may fail to relieve the patient’s original pain or even make it worse. There is also a small risk that the implant could be placed incorrectly, leading to stimulation in the wrong area. Furthermore, devices can sometimes provide insufficient or irregular stimulation.
Occasionally the wires that connect the stimulator to the generator can move and become exposed. This can cause symptoms such as redness and skin problems. In these cases, the wires will need to be removed.
Finally, some patients have an allergic reaction to their implant, although this is relatively rare. If someone is known to have an allergy to any of the materials in the device, they will not be considered suitable for PNS.
What to Expect
Following surgery, the patient may have to stay in hospital for several days. The length of the stay will depend on whether a trial is carried out, and for how long.
During their stay, patients will be shown how to control their device. They can turn it on or off, and control the level of stimulation.
The electrical pulses generated by a PNS device cause a mild tingling sensation in the local area. This can feel strange at first but is how the treatment works to relieve pain. Although some patients obtain good relief from PNS, others experience breakthrough pain and some see little effect at all.
The generator battery will need replacing every few years, depending on the type. Some are rechargeable and require replacing every 9 to 10 years. Non-rechargeable batteries require more frequent replacement, every two to five years.
