Percutaneous and Implanted Peripheral Nerve Stimulation for the Management of Pain: Current Evidence and Future Directions

  • Richard D. WilsonEmail author
  • Chong H. Kim
Rehabilitation Technology (R Harvey, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Rehabilitation Technology
  2. Topical Collection on Rehabilitation Technology


Purpose of Review

The goal of this review is to summarize the current state of percutaneous and implanted peripheral nerve stimulation for the relief of pain. This article provides an overview of commercially available devices, the evidence supporting their use, and novel treatments being considered for the future.

Recent Findings

There are four peripheral nerve stimulators commercially available in multiple countries around the world. The stimulation may be used temporarily, with percutaneous placement of leads, or indefinitely with permanent implantation of the leads. Two stimulation paradigms are described in the literature for treatment of pain—stimulation of motor (efferent) nerve fibers to create muscle contraction and stimulation of sensory (afferent) nerve fibers to create paresthesia.


Peripheral nerve stimulation has been studied in musculoskeletal pain syndromes, neuropathic pain syndromes, craniofacial pain, and in acute post-operative pain. This pain-relieving treatment is a promising treatment though many applications have not yet been well studied.


Pain Electrical stimulation Chronic pain Neuromodulation Peripheral nerve Rehabilitation 


Compliance with Ethical Standards

Conflict of Interest

Richard Wilson reports grants from and working on the advisory board for SPR Therapeutics, Inc. outside the submitted work. Chong Kim reports working as a consultant for SPR outside the submitted work.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Goldberg DS, McGee SJ. Pain as a global public health priority. BMC Public Health. 2011;11:770. Scholar
  2. 2.
    Hayat MJ, Howlader N, Reichman ME, Edwards BK. Cancer statistics, trends, and multiple primary cancer analyses from the Surveillance, Epidemiology, and End Results (SEER) program. Oncologist. 2007;12(1):20–37. Scholar
  3. 3.
    Toblin RL, Mack KA, Perveen G, Paulozzi LJ. A population-based survey of chronic pain and its treatment with prescription drugs. 2011;152(Pain 6):1249–55. Scholar
  4. 4.
    Hardt J, Jacobsen C, Goldberg J, Nickel R, Buchwald D. Prevalence of chronic pain in a representative sample in the United States. Pain Med. 2008;9(7):803–12. Scholar
  5. 5.
    Johannes CB, Le TK, Zhou X, Johnston JA, Dworkin RH. The prevalence of chronic pain in United States adults: results of an Internet-based survey. J Pain : Off J Am Pain Soc. 2010;11(11):1230–9. Scholar
  6. 6.
    IOM (Institute of Medicine). Relieving pain in America: a blueprint for transforming prevention, care, education, and research. Washington, DC: The National Academies Press; 2011. Report No.: 9780309256278Google Scholar
  7. 7.
    Geneen LJ, Moore RA, Clarke C, Martin D, Colvin LA, Smith BH. Physical activity and exercise for chronic pain in adults: an overview of Cochrane reviews. Cochrane Database Syst Rev. 2017;4:CD011279. Scholar
  8. 8.
    Duenas M, Ojeda B, Salazar A, Mico JA, Failde I. A review of chronic pain impact on patients, their social environment and the health care system. J Pain Res. 2016;9:457–67. Scholar
  9. 9.
    Mills SEE, Nicolson KP, Smith BH. Chronic pain: a review of its epidemiology and associated factors in population-based studies. Br J Anaesth. 2019;123(2):e273–e83. Scholar
  10. 10.
    Woolf CJ. Evidence for a central component of post-injury pain hypersensitivity. Nature. 1983;306(5944):686–8. Scholar
  11. 11.
    Latremoliere A, Woolf CJ. Central sensitization: a generator of pain hypersensitivity by central neural plasticity. J Pain : Off J Am Pain Soc. 2009;10(9):895–926. Scholar
  12. 12.
    Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011;152(3 Suppl):S2–15. Scholar
  13. 13.
    Wu CW, van Gelderen P, Hanakawa T, Yaseen Z, Cohen LG. Enduring representational plasticity after somatosensory stimulation. Neuroimage. 2005;27(4):872–84. Scholar
  14. 14.
    Chipchase LS, Schabrun SM, Hodges PW. Peripheral electrical stimulation to induce cortical plasticity: a systematic review of stimulus parameters. Clin Neurophysiol. 2010;122(3):456–63. Scholar
  15. 15.
    Kaelin-Lang A, Luft AR, Sawaki L, Burstein AH, Sohn YH, Cohen LG. Modulation of human corticomotor excitability by somatosensory input. J Physiol. 2002;540(Pt 2):623–33. Scholar
  16. 16.
    Ridding MC, Brouwer B, Miles TS, Pitcher JB, Thompson PD. Changes in muscle responses to stimulation of the motor cortex induced by peripheral nerve stimulation in human subjects. Exp Brain Res. 2000;131(1):135–43. Scholar
  17. 17.
    Ridding MC, McKay DR, Thompson PD, Miles TS. Changes in corticomotor representations induced by prolonged peripheral nerve stimulation in humans. Clin Neurophysiol. 2001;112(8):1461–9. Scholar
  18. 18.
    Deckers K, De Smedt K, Mitchell B, Vivian D, Russo M, Georgius P, et al. New therapy for refractory chronic mechanical low back pain-restorative neurostimulation to activate the lumbar multifidus: one year results of a prospective multicenter clinical trial. Neuromodulation. 2018;21(1):48–55. This 53-subject prospective trial demonstrates long-term relief of chronic low back pain with fully implanted mPNS.CrossRefPubMedGoogle Scholar
  19. 19.
    Russo M, Deckers K, Eldabe S, Kiesel K, Gilligan C, Vieceli J, et al. Muscle control and non-specific chronic low back pain. Neuromodulation. 2018;21(1):1–9. Scholar
  20. 20.
    Wilson RD, Knutson JS, Bennett ME, Chae J. The effect of peripheral nerve stimulation on shoulder biomechanics: a randomized controlled trial in comparison to physical therapy. Am J Phys Med Rehabil. 2017;96(3):191–8. Scholar
  21. 21.
    •• Wilson RD, Gunzler DD, Bennett ME, Chae J. Peripheral nerve stimulation compared with usual care for pain relief of hemiplegic shoulder pain: a randomized controlled trial. Am J Phys Med Rehabil. 2014a;93(1):17–28. 25-subject randomized, controlled trial establishes efficacy of percutaneous mPNS for chronic hemiplegic shoulder pain compared to an exercise treatment modality with a long-term carry over effect. CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    • Wilson RD, Bennett ME, Nguyen VQC, Bock WC, O'Dell MW, Watanabe TK, et al. Fully implantable peripheral nerve stimulation for hemiplegic shoulder pain: a multi-site case series with two-year follow-up. Neuromodulation. 2018;21(3):290–5. case series is important in showing that some with chronic hemiplegic shoulder pain who have temporary relief from pain when treated with percutaneous mPNS may benefit from a fully implanted mPNS system. CrossRefPubMedGoogle Scholar
  23. 23.
    McRoberts WP, Kim C, Sein M, Naftulin S, Huntoon M, Apostol C et al. The novel implantable peripheral nerve stimulator for post-stroke shoulder pain. neuromodulation. 2017;20(Abstracts From 2017 NANS 20th Annual Meeting, Las Vegas, NV, USA January 19–22, 2017.):e122-e335. doi:
  24. 24.
    • Wilson RD, Harris MA, Gunzler DD, Bennett ME, Chae J. Peripheral nerve stimulation for the treatment of chronic subacromial impingement syndrome: a case series. Neuromodulation. 2014b;17(8):771–6. case series suggests efficacy in reduction of chronic shoulder pain due to subacromial impingement syndrome with treatment from percutaneous mPNS. CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Cohen S, Gilmore C, Kapural L, Hanling S, Plunkett A, McGee M, et al. Percutaneous peripheral nerve stimulation for pain reduction and improvements in functional outcomes in chronic low back pain. Mil Med. 2019;184(Suppl 1):537–41. Scholar
  26. 26.
    Gilmore CA, Kapural L, McGee MJ, Boggs JW. Percutaneous peripheral nerve stimulation (PNS) for the treatment of chronic low back pain provides sustained relief. Neuromodulation. 2019a;22(5):615–20. This case series of 9 participants suggests efficacy of treatment of chronic low back pain with percutaneous mPNS.CrossRefPubMedGoogle Scholar
  27. 27.
    Ishizuka K, Oaklander AL, Chiocca EA. A retrospective analysis of reasons for reoperation following initially successful peripheral nerve stimulation. J Neurosurg. 2007;106(3):388–90. Scholar
  28. 28.
    McJunkin TL, Lynch PJ, Srejic E. Complications of peripheral nerve stimulation: open technique, percutaneous technique, and peripheral nerve field stimulation. In: Ranson M, Pope J, Deer T, editors. Reducing risks and complications of interventional pain procedures. Philadelphia: Elsevier Saunders; 2012.Google Scholar
  29. 29.
    Mobbs RJ, Nair S, Blum P. Peripheral nerve stimulation for the treatment of chronic pain. J Clin Neurosci. 2007;14(3):216–21; discussion 22-3. Scholar
  30. 30.
    Wall PD, Sweet WH. Temporary abolition of pain in man. Science. 1967;155(3758):108–9. Scholar
  31. 31.
    Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965;150(699):971–9. Scholar
  32. 32.
    Lee AW, Pilitsis JG. Spinal cord stimulation: indications and outcomes. Neurosurg Focus. 2006;21(6):e3. Scholar
  33. 33.
    Flor H, Nikolajsen L, Staehelin JT. Phantom limb pain: a case of maladaptive CNS plasticity? Nat Rev Neurosci. 2006;7(11):873–81. Scholar
  34. 34.
    Rauck RL, Cohen SP, Gilmore CA, North JM, Kapural L, Zang RH, et al. Treatment of post-amputation pain with peripheral nerve stimulation. Neuromodulation. 2014;17(2):188–97. Scholar
  35. 35.
    Gilmore CA, Ilfeld BM, Rosenow JM, Li S, Desai MJ, Hunter CW, et al. Percutaneous 60-day peripheral nerve stimulation implant provides sustained relief of chronic pain following amputation: 12-month follow-up of a randomized, double-blind, placebo-controlled trial. Reg Anesth Pain Med. 2019b.
  36. 36.
    Antony AB, Mazzola AJ, Dhaliwal GS, Hunter CW. Neurostimulation for the treatment of chronic head and facial pain: a literature review. Pain Physician. 2019;22(5):447–77.PubMedGoogle Scholar
  37. 37.
    Dodick DW, Silberstein SD, Reed KL, Deer TR, Slavin KV, Huh B, et al. Safety and efficacy of peripheral nerve stimulation of the occipital nerves for the management of chronic migraine: long-term results from a randomized, multicenter, double-blinded, controlled study. Cephalalgia. 2015;35(4):344–58. Scholar
  38. 38.
    Silberstein SD, Dodick DW, Saper J, Huh B, Slavin KV, Sharan A, et al. Safety and efficacy of peripheral nerve stimulation of the occipital nerves for the management of chronic migraine: results from a randomized, multicenter, double-blinded, controlled study. Cephalalgia. 2012;32(16):1165–79. Scholar
  39. 39.
    Ilfeld BM, Said ET, Finneran JJ, Sztain JF, Abramson WB, Gabriel RA, et al. Ultrasound-guided percutaneous peripheral nerve stimulation: neuromodulation of the femoral nerve for postoperative analgesia following ambulatory anterior cruciate ligament reconstruction: a proof of concept study. Neuromodulation. 2019a;22(5):621–9. Scholar
  40. 40.
    Ilfeld BM, Ball ST, Gabriel RA, Sztain JF, Monahan AM, Abramson WB, et al. A feasibility study of percutaneous peripheral nerve stimulation for the treatment of postoperative pain following total knee arthroplasty. Neuromodulation. 2019b;22(5):653–60. Scholar
  41. 41.
    Ilfeld BM, Finneran JJ, Gabriel RA, Said ET, Nguyen PL, Abramson WB, et al. Ultrasound-guided percutaneous peripheral nerve stimulation: neuromodulation of the suprascapular nerve and brachial plexus for postoperative analgesia following ambulatory rotator cuff repair. A proof-of-concept study. Reg Anesth Pain Med. 2019c. Scholar
  42. 42.
    Ilfeld BM, Gabriel RA, Said ET, Monahan AM, Sztain JF, Abramson WB, et al. Ultrasound-guided percutaneous peripheral nerve stimulation: neuromodulation of the sciatic nerve for postoperative analgesia following ambulatory foot surgery, a proof-of-concept study. Reg Anesth Pain Med. 2018;43(6):580–9. Scholar
  43. 43.
    Deer TR, Levy RM, Rosenfeld EL. Prospective clinical study of a new implantable peripheral nerve stimulation device to treat chronic pain. Clin J Pain. 2010;26(5):359–72. Scholar
  44. 44.
    Oswald J, Shahi V, Chakravarthy KV. Prospective case series on the use of peripheral nerve stimulation for focal mononeuropathy treatment. Pain Manag. 2019;9(6):551–8. Scholar
  45. 45.
    •• Deer T, Pope J, Benyamin R, Vallejo R, Friedman A, Caraway D, et al. Prospective, multicenter, randomized, double-blinded, partial crossover study to assess the safety and efficacy of the novel neuromodulation system in the treatment of patients with chronic pain of peripheral nerve origin. Neuromodulation. 2016;19(1):91–100. multi-site randomized controlled trial establishes efficacy and safety of fully implanted sPNS in the treatment of chronic pain due to peripheral nerve injury after trauma or surgery. CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2020

Authors and Affiliations

  1. 1.MetroHealth Rehabilitation Institute, Case Western Reserve University, Cleveland FES CenterClevelandUSA

Personalised recommendations