Peripheral nerve stimulation in New Jersey is a minimally invasive treatment that uses mild electrical pulses near a specific nerve to help manage chronic neuropathic pain. Dr. Dipan Patel, a double board-certified interventional pain physician, offers a trial first and, if the trial is successful, a permanent implant. He most often uses PNS for chronic neuropathic pain after injuries of the knee, shoulder, or ankle. He sees patients in Clifton, Edison, West Orange, Jersey City, and Hazlet, New Jersey.
A Trial-First Option for Chronic Neuropathic Pain
Peripheral nerve stimulation (PNS) delivers mild electrical pulses through a thin lead placed next to a peripheral nerve — a nerve outside the spinal cord. Those pulses can change pain signals before they reach the spinal cord and brain. FDA-cleared implanted PNS systems in this category are indicated for pain management in adults who have severe, intractable chronic pain of peripheral nerve origin, as the sole mitigating agent or as an adjunct to other modes of therapy, and are not intended to treat pain in the craniofacial region (see, for example, FDA 510(k) K232415). Dr. Patel starts with a temporary trial so you can find out whether stimulation helps before any permanent implant is considered.
How Does Peripheral Nerve Stimulation Work?
A lead is placed next to the target nerve using ultrasound, fluoroscopy (live X-ray), or both, as described in consensus guidelines from the American Society of Pain and Neuroscience (ASPN). The lead is connected to a pulse generator that you can adjust within prescribed settings. Unlike spinal cord stimulation, the lead is not placed in the epidural space; it stays at the peripheral nerve — for example, a genicular or saphenous nerve at the knee, an axillary or suprascapular nerve at the shoulder, or a sural, superficial peroneal, or posterior tibial nerve at the ankle. PNS does not cure the nerve injury. It is used to reduce neuropathic pain enough to help you function better.
Benefits of Peripheral Nerve Stimulation:
- Can be tested first with a temporary trial before any permanent implant
- Targets a specific peripheral nerve rather than the spinal cord
- Adjustable stimulation settings after the implant
- A minimally invasive, image-guided procedure
- May be considered for selected chronic neuropathic pain at the knee, shoulder, or ankle after other care has not been enough
What Does Peripheral Nerve Stimulation Treat?
Dr. Patel most often uses PNS for chronic neuropathic pain after injuries — and, in some cases, after surgery — involving the knee, shoulder, or ankle. That can include nerve-related pain that has continued when medicines, physical therapy, and less invasive procedures have not been enough. The ASPN guidelines review PNS for selected pain at these regions, including genicular-nerve targets for the knee and named nerves at the shoulder and ankle. PNS is not a treatment for every type of joint pain, and it is not the same as a joint injection or ablation. It may also be discussed for selected post-surgical pain when a peripheral nerve is the likely source.
Am I a Candidate for PNS?
You may be considered if you have chronic, intractable neuropathic pain of peripheral nerve origin that has not improved enough with conservative care and other appropriate treatments. A nerve block is sometimes used first to help confirm the target. A temporary trial is then used to see whether stimulation helps you enough to consider a permanent implant. Candidacy is individualized and depends on the nerve involved, your overall health, and imaging or exam findings.
This page cannot determine whether PNS is right for you. Dr. Patel will review other options as well, including whether spinal cord stimulation or a different procedure is a better match for your pain pattern.
What Happens During a PNS Trial and Implant?
The trial. Under local anesthesia and, when appropriate, light sedation, Dr. Patel places a temporary lead next to the target nerve, using ultrasound or fluoroscopy. The lead is connected to an external generator that you wear for the trial, which the ASPN guidelines describe as typically about one week. You can adjust stimulation within the prescribed range and keep track of your pain and function. If the trial does not provide satisfactory relief, the lead is removed and a permanent system is not implanted.
The implant. If the trial is successful — often defined as more than 50% pain improvement, per the same guidelines — you may proceed to a permanent implant. A lead is placed at the same nerve and connected to a pulse generator or receiver. Depending on the system, the generator may sit under the skin, or a small wearable unit may power an implanted receiver. Dr. Patel will explain the specific system he recommends, how it is powered, and what follow-up involves. Many insurers require a successful trial before they will consider covering a permanent implant.
What Is Recovery Like After PNS?
You may have soreness at the lead or generator site for a few days. Dr. Patel will give you instructions about activity, wound care, and when you can return to work or exercise — including any limits on stretching or lifting that could pull on a new lead. After a permanent implant, you will also learn how to use the controller and what symptoms should prompt a call to the office. Recovery is individual; follow the plan you are given rather than a general timeline from this page.
How Long Does the Implanted System Last?
That depends on the specific system, how it is powered, and how it is used. Some generators have an internal battery; others are powered by an external wearable. Batteries that deplete can often be replaced in a later procedure. The system can generally be turned off and, if needed, surgically removed. Because hardware designs differ, this page does not quote a single battery life. Dr. Patel will review those details for the device used in your care. Complications such as lead migration, lead erosion, infection, or device malfunction can require additional procedures, as noted in the ASPN guidelines.
Why Choose Dr. Patel for Peripheral Nerve Stimulation?
Dr. Dipan Patel is a double board-certified interventional pain physician with fellowship training at NYU Langone. He specializes in minimally invasive neuromodulation, including spinal cord stimulation and peripheral nerve stimulation. For PNS, he emphasizes a trial first and uses the therapy most often for chronic neuropathic pain after knee, shoulder, or ankle injury. He sees patients in Clifton, Edison, West Orange, Jersey City, and Hazlet, New Jersey. If you are living with this kind of nerve pain and other treatments have not been enough, schedule your consultation today to discuss whether a PNS trial is appropriate. Call 973-777-5444.
Frequently asked questions
What is peripheral nerve stimulation?
Peripheral nerve stimulation (PNS) uses mild electrical pulses delivered near a specific nerve outside the spinal cord to change pain signals. A thin lead is placed next to the target nerve and connected to a pulse generator. FDA-cleared implanted systems in this device class are indicated for pain management in adults with severe, intractable chronic pain of peripheral nerve origin, as the sole mitigating agent or as an adjunct to other modes of therapy, and are not intended to treat pain in the craniofacial region. See an example FDA 510(k) clearance (K232415) for this device category. PNS does not cure the underlying nerve injury.
Why is there a trial first?
Permanent PNS is typically offered in two steps, similar to spinal cord stimulation. Consensus guidelines from the American Society of Pain and Neuroscience (ASPN) describe a temporary trial, typically about one week, followed by a permanent implant if the trial is successful. Those guidelines define satisfactory trial relief as more than 50% improvement in pain. A diagnostic nerve block is sometimes used first to help identify the target nerve. If the trial does not help enough, the temporary leads are removed and a permanent implant is not placed.
What kinds of pain does Dr. Patel use PNS for?
Dr. Patel most often uses PNS for chronic neuropathic pain after injuries of the knee, shoulder, or ankle. The ASPN guidelines review stimulation of genicular and saphenous nerves for selected knee pain, axillary and suprascapular nerves for selected shoulder pain, and nerves such as the sural, superficial peroneal, and posterior tibial nerves for selected ankle and foot pain. See the ASPN consensus guidelines and this site’s pages on neuropathic pain and post-surgical pain. Candidacy is always individual.
How is PNS different from spinal cord stimulation?
Both therapies use electrical pulses to modify pain signals, and both are often tested with a trial before a permanent implant. The difference is the target. Spinal cord stimulation places leads in the epidural space over the spinal cord. PNS places leads next to a specific peripheral nerve — for example, a nerve at the knee, shoulder, or ankle — and does not enter the spinal canal. That also means PNS avoids certain spinal risks of SCS, such as dural puncture, as noted in the ASPN guidelines. Dr. Patel will explain which approach, if either, matches your pain pattern.
What are the risks?
The ASPN guidelines group complications into hardware-related and biological. Hardware issues can include lead migration (which can be more common with PNS than with spinal cord stimulation), lead fracture, lead erosion, and malfunction of the lead or generator. Biological issues can include infection (superficial or deep) and pain over the implant site. Undesirable motor stimulation or painful stimulation can occur if a lead is very close to the nerve or if amplitude is high. Serious complications are described as uncommon, but they are not impossible. Dr. Patel will review risks that apply to you, including MRI considerations for the specific system used.
If the trial helps, what is the implant like?
If you have satisfactory relief during the trial, a permanent lead is placed near the same nerve and connected to a pulse generator or receiver, which may be implanted under the skin or, in some systems, powered by a small external wearable. Details vary by device. Imaging with ultrasound, fluoroscopy, or both is used to guide placement, as described in the ASPN guidelines. You and Dr. Patel can adjust settings after the implant. The system can generally be turned off, and, if needed, it can be surgically removed.
Will I be pain-free? Is it covered by insurance?
The realistic goal is a meaningful reduction in pain and an improvement in function, not a guaranteed cure. PNS does not repair the injured nerve. Results vary, and a successful trial is used to judge whether an implant is worth considering. Insurance coverage varies by plan. Medicare and many other payors require an effective trial before a permanent implant, as summarized in the ASPN guidelines. Our office can help check your benefits after an evaluation. Call 973-777-5444.