Peripheral nerve stimulation has come a long way from its early days, Timothy Deer, MD, told Pain Medicine News in this final episode of ON PAIN Neuromodulation. Today it can even be used in the short term to “dose electricity,” said Deer, who is the CEO and president of the Spine and Nerve Centers of the Virginias in Charleston, W.Va. Deer is also a clinical professor of anesthesiology and pain medicine at West Virginia University, in Morgantown, and a member of the Pain Medicine News editorial advisory board.

Meaghan Lee Callaghan  00:01
What about peripheral nerve stimulation?

Timothy Deer, MD  00:04
So, I’ll just give a little history of peripheral nerve stimulation. You know, when I first started doing peripheral nerve stimulation back about 25 years ago, we would make a cut down to the nerve, we would find the nerve, we would open up and dissect the nerve, we take a piece of fascia, put it on top of the nerve, and then we take a paddle lead designed for spinal cord stimulation and put on top of the nerve.

Deer  00:36
And that was a big process. It would take a long time. And then patients didn’t do very well long term. And that’s really evolving. It’s really getting much, much better. Now we can do things like 60-day treatments, where we put a little wire around a nerve. So, let’s say, for example, you had surgery on your hand, and you have nerve damage and you have severe pain in your hand. When the old days we had need to put a device in your neck, or we just had to say, ‘Well, we can’t really help you,’ or we put a device that was made for the spine in your arm, which makes no sense. Right? But in newer therapies, now we can actually put a device in around the nerve. And some of those therapies are permanent, but some of them may only be needed for 60 days. And there are patients where the brain changes in that 60-day window where the pain improves. So, for patients, that’s a very low commitment. You know, they have a procedure that we do in the office with ultrasound guidance, put a little wire in, and then 60 days from now they can decide if they’re good enough, that might be all they ever need. It’s like dosing electricity. But if they’re not good enough, then they can have a permanent device put in under the skin, or they can have a permanent device in their spinal cord. 

Callaghan  01:38
So what devices are appropriate for different kinds of pain? 

Deer  01:43
Let’s say, for example, you have someone that their pain is severe and they have complex regional pain syndrome. I’m going to go to dorsal root ganglion simulation, but let’s say they have pain in the area of a nerve that is moderately bad, then peripheral nerve stimulation is a very good choice because it’s not as invasive. So the success rates have not been as high as in the spine. But again, it’s that’s largely because, you know, we really haven’t done as well-designed studies yet. And I think we’ll keep getting better with the devices and with study design. So, that’s what it involves. For patients, though, it’s low risk. We usually do that in the office, at least the temporary part with ultrasound guidance. They go home an hour or so later, and if it responds and it saves them the need for a spinal cord procedure.

—PMN Staff