Evidence-Based Clinical Guidelines from the American Society of Pain and Neuroscience for the Use of Implantable Peripheral Nerve Stimulation in the Treatment of Chronic Pain.

The objective of this peripheral nerve stimulation consensus guideline is to add to the current family of consensus practice guidelines and incorporate a systematic review process. The published literature was searched from relevant electronic databases, including PubMed, Scopus, Cochrane Central Register of Controlled Trials, and Web of Science from database inception to March 29, 2021. Inclusion criteria encompassed studies that described peripheral nerve stimulation in patients in terms of clinical outcomes for various pain conditions, physiological mechanism of action, surgical technique, technique of placement, and adverse events. Twenty randomized controlled trials and 33 prospective observational studies were included in the systematic review process. There is Level I evidence supporting the efficacy of PNS for treatment of chronic migraine headaches via occipital nerve stimulation; chronic hemiplegic shoulder pain via stimulation of nerves innervating the trapezius, supraspinatus, and deltoid muscles; failed back surgery syndrome via subcutaneous peripheral field stimulation; and lower extremity neuropathic and lower extremity post-amputation pain. Evidence from current Level I studies combined with newer technologies facilitating less invasive and easier electrode placement make peripheral nerve stimulation an attractive alternative for managing patients with complex pain disorders. Peripheral nerve stimulation should be used judiciously as an adjunct for chronic and acute postoperative pain following adequate patient screening and positive diagnostic nerve block or stimulation trial.

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© 2022 Strand et al.

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Dr Jonathan M Hagedorn reports personal fees from Abbott, Boston Scientific, Medtronic, Nevro, and Saluda, outside the submitted work. Dr Scott Pritzlaff reports personal fees from EBT Medical, SPR Therapeutics, and Nalu Medical, during the conduct of the study. Dr Dawood Sayed reports grants from Spr, during the conduct of the study; personal fees from Spr, Nevro, Medtronic, and Abbott, outside the submitted work. Dr Alexander Escobar reports personal fees from Abbott, personal fees from Boston Scientific, personal fees from Medtronic, personal fees from Nevro, outside the submitted work. Dr Mark Huntoon reports fees from SPR for consulting and teaching, outside the submitted work; and Saluda- Membership on Clinical Events Committee for national study. Dr Timothy R Deer reports personal fees, from Abbott, personal fees, from Vertos, grants from Flowonix, personal fees, from SpineThera, personal fees, from Saluda, from Mainstay, personal fees, from Nalu, personal fees, from Cornerloc, personal fees, from Ethos, personal fees, from SPR Therapuetics, personal fees from SI Bone, personal fees from Nevro, personal fees from Medtronic, personal fees, from Boston Scientific, personal fees, from PainTeq, personal fees from Tissue Tech, personal fees, from Spinal Simplicity, from Avanos, outside the submitted work; in addition, Dr Timothy R Deer has a patent Abbott pending to DRG Leads pending. The authors report no other conflicts of interest in this work.