Peripheral Nerve Field Stimulation for Sacroiliac Joint Pain

Spinal cord stimulation for neuropathic pain: current perspectives

“…First publications on PNFS dealt with chronic abdominal pain 56,57. Later, studies concerning chronic thoracic pain,58,59 chronic low back pain,60–63 failed back surgery syndrome (FBSS),64,65 and sacroiliac joint pain66 also were published.…”

Intractable sacroiliac joint pain treated with peripheral nerve field stimulation

“…[6] One advantage of subcutaneous lead implantation is that the continuity of subcutaneous tissue layer across the large areas of body allow the electrical stimulation currents across the leads (called cross-talking) to travel large distances[6] when compared to other neurostimulation techniques (spinal cord stimulation and peripheral nerve stimulation), wherein the leads have to be fixed within narrow distance of its efficacy (<10 mm for spinal cord stimulation vs. maximal >30 inches for PNFS)[6] to achieve appropriate stimulation in painful areas. Conversely, if pain extends over large surface areas and PNFS is not able to generate adequate electrical stimulation across those large areas, the patient will need supplementation with other analgesics and interventions[5] even though requirements of these supplementations for achieving appropriate analgesic efficacy may be much lower with PNFS than without PNFS.…”

“…Per results of these multicenter trials, PNFS can be safe, easy and good treatment option for intractable low back pain patients who are not or have stopped responding to conventional medical and interventional pain management. Although it has been reported ( n = 23) that age above 60 years can contribute to decreased analgesic efficacy of PNFS in chronic pain,[9] the report of 10 cases[5] had three patients aged 80 years and above but nevertheless concluded that 80% patients showed some benefits and 60% patients reported significant improvements[5] with PNFS for SIJ pain. Alternatively, even though PNFS will be the last resort treatment option (due to invasiveness, costs and clinical management/follow-up for standard complications related to implantable neurostimulators) for SIJ pain (diagnosed by default at the time of first-line diagnostic pain interventions),[1] PNFS permanent leads implanted at the most painful area in the lower back area for chronic pain can still provide analgesic efficacy irrespective of whether SIJ pain was confirmed or not confirmed by diagnostic pain intervention (approximately 20% are false-positives anyway)[1] as the underlying cause for chronic low back pain.…”

“…[78] Alternatively, the technical precautions that has to be considered with PNFS in SIJ area are large amounts of fat tissue around buttocks that may interfere with adequate cross-talking between subcutaneous leads due to linear correlation between electrical bio-impedance variability and variable thickness of subcutaneous fat layers. [10] In addition, as compared to vertical (cranio-caudal) leads placements performed by our team for unilateral SIJ pain, horizontal leads placements[5] may be a better option when SIJ pain is bilateral (that may often be the case);[5] however, the horizontal leads (due to their location and inter-lead distance) may be providing more generalized pain relief for the chronic low back and buttock pain when compared to the vertical leads implanted over painful SIJ area that may be providing more focused pain relief for SIJ pain.…”

“…[4] Recently, there was a report about the novel use of peripheral nerve field stimulation (PNFS) for SIJ pain. [5] Hereby, we report our pain-clinic experience with PNFS for two patients of intractable SIJ pain although for reimbursement purposes, the third-party payers (medical insurance companies) consider PNFS as an investigational procedure in USA due to insufficient evidence for its analgesic efficacy.…”