Stimulation of the Extraspinal Peripheral Nervous System

Much like the carpenter’s hammer, the pain interventionalist’s needle begs its own substrate, and none serves like the peripheral nerve. Peripheral nerve stimulation (PNS), peripheral nerve field stimulation (PNfS), and hybrid stimulation (creating a paresthetic field of stimulation by sending current between spinal and peripheral leads at a distance from each other) are all areas of neuromodulation growing in interest from both clinical and research standpoints. The increasing use of these modalities reflects not only the efficacy, safety, and increasing technical ease with which the treatment can be delivered, but also the reports of successful relief from often obstinate and disabling pain. This surgical technique has shown growing potential in patients suffering from many severe pain conditions, including low back pain, intercostal neuralgia, ilioinguinal neuralgia, carpal tunnel syndrome, neuropathic facial pain, nerve entrapment syndromes, postsurgical nerve pain, and specific neuropathic pain isolated to confined areas of the body. This chapter seeks to tutor the neuromodulation community about the utility of the peripheral technique and its points of finesse, so that the sensitive recipient of peripheral neuromodulation is never treated bluntly, unlike the nail.