Peripheral nerve field stimulation for chronic low back pain

• peripheral nerve-field stimulation (PNFS) for chronic low back pain is less invasive than spinal cord stimulation or spinal fusion and offers a reversible method of pain control for those with severe refractory pain
  • procedure is usually done in 2 stages:
    
    
    • first, electrodes are implanted and connected to a neurostimulator. If this produces benefit over a trial of several days then the patient receives a fully implanted system, at a second operation
      • procedure is done using local anaesthesia.
        • one or more lead(s) are introduced percutaneously into the subcutaneous tissues of the lower back
        • depending on the patient's pain pattern, areas of pain and anticipated changes in the patient's condition, it may be appropriate to implant several leads
        • implanting several leads may provide greater flexibility for covering the patient's pain pattern with paraesthesia
        • intra-operative stimulation is used to verify that the electrodes have been correctly placed
        • the lead(s) are tunnelled under the skin to a distant exit site and connected by an external extension lead to a hand-held neurostimulator. The patient is able to change the stimulation settings within limits set by the clinician
          
          
    • second stage is carried out if the trial is successful
      • local anaesthesia is used (sometimes with sedation)
      • a subcutaneous pouch is formed for the implantable neurostimulator, which is connected to the already implanted trial electrodes. The patient has a hand-held remote control that permits stimulation within set parameters. The system can be removed if desired.

NICE state that (1)

• ".....current evidence on the efficacy of peripheral nerve-field stimulation (PNFS) for chronic low back pain is limited in both quantity and quality, and duration of follow-up is limited. Evidence on safety is also limited and there is a risk of complications from any implanted device. Therefore this procedure should only be used with special arrangements for clinical governance, consent and audit or research...."

Reference:

• (1) NICE (March 2013). Peripheral nerve-field stimulation for chronic low back pain