Peripheral Nerve Stimulation (PNS)

What Is Peripheral Nerve Stimulation (PNS)

Peripheral nerve stimulation (PNS) is a minimally invasive treatment for people living with chronic pain. The same-day procedure is safe and can offer significant relief to patients for whom traditional pain relief options, such as medication and pain management strategies, have not been effective.

The multidisciplinary team at Cleveland Clinic Abu Dhabi's Interventional Pain Management Center, which consists of interventional pain physicians, pain management nurses, psychologists, and physical therapists, were the first in the UAE to offer PNS treatment.

Peripheral nerves are the nerves that extend outside of our central nervous system (consisting of the brain and spinal cord) to our organs and extremities.

PNS involves implanting a device under ultrasound guidance, which targets the precise peripheral nerves that are causing the pain.

A very thin wire is implanted next to the nerve which delivers electrical stimulation. These electrical pulses interfere with the pain signals that are being sent from the source of the pain to the brain, and change the way that your brain perceives the pain.

What PNS can treat?

PNS can treat pain in almost all areas of the body, including, but not limited to:

• Chronic neuropathic pain of the upper and lower extremities
• Persistent shoulder and knee pain
• Groin pain or nerve pain after surgery
• Compression of nerves after stroke
• Chronic back pain
• Intractable headache with occipital nerve irritation

What happens before the procedure?

Please arrive at least 30 minutes early on the day of your PNS procedure. Once you reach the Interventional Pain Management Center, you will complete your clinic registration and any other paperwork which is required (you will need to bring your insurance card and Emirates ID).

Once your registration is complete, you will meet with members of the Interventional Pain Management team. A nurse will perform a physical assessment, discuss your medical history, and ask about any current medications you are taking. Your doctor will then meet with you to discuss the procedure in detail with you and perform a medical evaluation.

You must not eat anything for 6 hours before your appointment. You can dink clear liquids during this time, but not in the 2 hours before your procedure.

If you are diabetic, your doctor will talk to you about adjusting your insulin dose. Do not take any pain medication 4 hours before the procedure. Your doctor will discuss any other medications with you, so please remember to bring them so you can take them after the procedure.

You may be given a mild sedative via an intravenous (IV) line in your arm, to help you relax.

If any of the following apply to you, it is very important to tell your doctor in advance of the procedure:

• You might pregnant, or you are breastfeeding
• You currently have an infection
• You take blood thinning medication (always talk to your doctor before stopping any medication prescribed to you)

Please note, a responsible adult must accompany you on the day of your procedure, who can drive you home afterwards.

What happens during the procedure?

The medical team will first clean the procedure area with antiseptic solution. The area is then numbed with a local anesthetic.

A small wire no wider than a human hair (the electrode) is then implanted. An ultrasound or X-ray is used to guide the stimulator close to the peripheral nerve (the source of the pain). A small pulse generator is connected which is either implanted internally or stays outside the body. The team will test the PNS during the procedure to assess the pain relief.

The entire procedure takes between 30 and 60 minutes, after which you will be transferred to a recovery room.

What happens after the procedure?

The medical team keep you in the recovery room for a short time to observe your vital signs. You will be offered pain relief. They will discuss how to operate the stimulation device and give you discharge instructions, which include the following:

• Only take showers (don't bathe or go swimming) for the first week
• Don't remove any dressings
• Wait 24 hours before driving or using any machinery
• Don't do any strenuous activity for at least 4 weeks

If you experience any of the following, speak to your doctor or go to the emergency room immediately (telling them that you have had an epidural injection recently):

• Fever or nausea/vomiting
• Numbness in your legs, arms, or feet for more than 8 hours
• Pain or bleeding at the injection site or incision site
• Persistent headacheInability to control your blood sugar levels
• Loss of bladder or bowel control
• Unable to pass urine for more than 8 hours
• Uncontrolled blood sugar or blood pressure
• Inability to control bowel or bladder
• Inability to urinate after 8 hours

To know more about interventional pain, please visit our multidisciplinary care model of Interventional Pain Management.

If you have any questions or concerns, please call Cleveland Clinic Abu Dhabi at 800 8 CCAD (2223), extension 19064.