Aashish Kumar, MD, shows Diane Woods Carter a peripheral nerve stimulator before her procedure.
Peripheral nerve stimulation is becoming a popular treatment option for everything from stubborn back pain to rare neuropathies. Compared with opioid pain killers, peripheral nerve stimulation technology works better, lasts longer, and carries no risk of dependence.
“There is a role for opioids and other medications in pain management, but they come with side effects. They come with abuse potential,” said Aashish Jay Kumar, MD, a pain medicine and interventional spine specialist at Duke who performs peripheral nerve stimulation procedures. “Peripheral nerve stimulation could be life-changing for a lot of people.”
Here, Dr. Kumar explains how peripheral nerve stimulation works and whether you could benefit from it.
What Is Peripheral Nerve Stimulation?
Peripheral nerve stimulation uses electrical energy to block specific nerves from sending pain signals to the brain. Delivering tiny electrical impulses to the nerve changes how it behaves and how often it fires.
“Some data show that peripheral nerve stimulation actually changes signaling in the brain and how it perceives and responds to chronic pain,” Dr. Kumar said. Because of the high frequency of the stimulation, you can’t feel it.
What Is the Placement Procedure Like?
Pain management specialists like Dr. Kumar first identify which nerves in your body are causing chronic pain. Then, doctors use X-ray and ultrasound guidance to precisely place a thin electrode or lead next to the target nerve. The end of the lead, which can be as thin a spaghetti noodle or a sewing thread, is either hidden under your skin or exits through your skin and is secured.
A removable, wearable transmitter and battery complete the device. After the peripheral nerve stimulation system is turned on, a handheld remote allows you to communicate with the system, customize your device settings, and maximize your pain relief.
What Types of Peripheral Nerve Stimulation Devices Are Available?
Duke offers three types of peripheral nerve stimulation devices, all of which are highly effective and low risk. Each device has its own strengths and may deliver different results depending on the type and location of your pain.
SPRINT and Bioness StimRouter
Of the three Duke-approved peripheral nerve stimulation devices, the SPRINT system is the least permanent. The SPRINT device is removed after 60 days but promises pain relief for up to -- and sometimes beyond -- two years. The small, lightweight transmitter and battery are worn on your skin. There is one drawback: the SPRINT system can’t be submerged, so although you can shower normally, you won’t be able to swim or take a bath during the 60 days when you are wearing the device.
The Bioness StimRouter system is similar to SPRINT, except that it is permanent and can be submerged in water.
Both the SPRINT and Bioness StimRouter systems are placed in an outpatient clinic during short, minimally invasive procedures using only local anesthesia.
Unlike the other two devices, the Stimwave requires a week-long trial period, and the placement procedure is done in an operating room. Because the procedure is more involved, the Stimwave device is not turned on right away; you’ll need to return to the clinic for device programming. The Stimwave transmitter and battery are larger and must be clipped to your clothing or worn with a Velcro strap. However, the Stimwave has been shown to be very effective with certain types of pain, including chronic headaches.
Am I a Candidate for Peripheral Nerve Stimulation?
According to Dr. Kumar, peripheral nerve stimulation is ideal for any type of chronic pain that is isolated (meaning it doesn’t radiate out into other areas of the body) and has an identifiable nerve target. This would include pain in your shoulder or knee, fibromyalgia, diabetic neuropathy, chronic regional pain syndrome (CRPS), and migraines, to name a few. If you have chronic pain and other treatments have failed or you want to take less medication, a pain medicine specialist can help you determine whether peripheral nerve stimulation is right for you.
“At Duke, we want to be at the forefront of this revolution in pain management,” Dr. Kumar said. “It’s incredibly rewarding to help people get back to living their lives with less pain.”