Peripheral Nerve Stimulator

This is the technique where electrodes are placed parallel to a peripheral nerve to help with pain. The idea is to replace the pain sensation with a more pleasant sensation and thus inhibition of pain long term. This type of device does not require an implanted generator but is rather a small key fob like device that can be worn on the body. This procedure can be performed under local anaesthesia, light sedation or general anaesthesia. This is a same day procedure. This particular device can help patients who are suffering from chronic postoperative pain (especially after shoulder or knee surgeries), occipital neuralgia, complex regional pain syndrome, chest pain after surgery or radiation, pain in the amputation stump, pain following inguinal hernia surgery and some selective conditions which lead to chronic back or neck pain.

To get an estimate of peripheral nerve stimulator cost in New Jersey, book an appointment with the experts at Mainland Pain Management. 

Peripheral nerve stimulator

Peripheral nerve stimulation or PNS is another approach to treat chronic pain. It involves minimally invasive placement of electrodes parallel to peripheral nerve. It is often performed under ultrasound or X ray guidance. The electrodes deliver rapid electrical pulses that feel like tingling or paresthesia. These electrodes are then connected to an external generator. Patients are in control of the device as they can turn the device on or off.

Who is a candidate for peripheral nerve stimulator or nerve block

Patients who have neuropathy in a particular nerve are candidates for peripheral nerve block or stimulation. The pain that is not resolved with medications, physical therapy and which causes significant sleep disturbance or decreased function, altogether chronic pain can be treated with peripheral nerve blocks and or stimulators.

Common nerves include

  • Medial/ulnar/radial nerves: cause of pain in hands
  • Greater occipital nerve: Occipital neuralgia causing headaches
  • Cluneal nerve: pain in the buttocks
  • Pudendal nerve: causing pelvic pain
  • Femoral/sciatic/obturator nerve: pain in thigh
  • Brachial/lumbar plexus neuropathy: hand, arm, leg pain
  • Meralgia paresthetica: thigh pain
  • Lumbar/cervical radiculitis: pain in arms, hands, legs or feet
  • Intercostal neuralgia: Chest wall pain

How to prepare

  • Your physician might send you to Physical therapy or chiropractor before starting any treatment. You may be prescribed anti-inflammatory medications and or nerve pain medications such as Gabapentin, lyrica, cymbalta or amitriptyline before any interventions.
  • You will need X rays and MRI before any diagnostic blocks.
  • You might need EMG/ nerve conduction studies before surgery.
  • Before the peripheral nerve stimulator you will get nerve blocks in the same nerve to find out if it alleviates most of your pain. If the nerve blocks do not provide long lasting relief , you might be a candidate for peripheral nerve stimulator.
  • Like most pain procedures you will need to hold blood thinners prior to procedures. Your physician will get clearance to hold the medications from prescribing providers before the procedure. You might need additional blood tests if deemed necessary given your medical conditions.
  • Though these are minimally invasive procedures you can ask your physician for moderate or deep sedation for these procedures.

On the day of procedure

  • You will be asked to not eat anything 8 hours prior to procedure
  • You can have all your medications with a sip of water or pulpless apple juice. You can have black coffee up to 2 hours prior to procedure
  • You will need to hold blood thinners, the provider will provide you information regarding what medications need to be held, and for how long, prior to the procedure.
  • You will need a responsible adult to bring you to and from the procedure as you will not be able to drive 24 hours of the procedure

The procedure is usually performed using deep sedation or general anaesthesia, typically you will talk to the anaesthesia team or sedation team prior to the procedure.
The position for the procedure will depend on the nerve being targeted. The surgeon will talk to you more about procedural details prior to procedure. This is a sterile procedure. After a small incision on the skin the electrode is placed using ultrasound or fluoroscopy guidance. After testing for proper placement the incision is closed with sutures. There will be bandage around the site of procedure. You will be prescribed pain medications for any procedure related pain

Recovery

You can go home after the surgery and recovery from anaesthesia. Avoid pulling, stretching, lifting after the surgery. Dressings will be there on incisions, which can be removed after 3-4 days. Incisions heal 2-4 weeks after surgery.
Light activity is encouraged 2 weeks after surgery, you can walk about the day after surgery. Once approved by the surgeon, you can drive or work after the surgery.
It is best to avoid soaking, swimming pool for 2 weeks after the surgery.
You will be following up with the surgeon 2-3 weeks after surgery for suture removal.

To learn more about this treatment or peripheral nerve stimulator cost in New Jersey, book a consultation at Mainland Pain Management with Dr. Dipty Mangla.

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