8 | | NOVEMBER 2023By Scott G. Pritzlaff, MD, Associate Professor and Department of Anesthesiology and Pain Medicine, UC Davis HealthIN THE BATTLE AGAINST PAIN:HOW PERIPHERAL NERVE STIMULATION IS CHANGING THE GAME FOR CLINICIANS AND PATIENTS WITH NERVE PAININ MY OPINIONIN MY OPINIONChronic pain affects as many as 100 million Americans yearly and is an enormous economic burden. Traditional pain management methods, such as opioids, often come with a host of adverse side effects that can lead to further disability and reduced quality of life. Neuromodulation is a rapidly advancing field of medicine with the potential to change the way we treat pain. Neuromodulation uses electricity to modulate pain from the central or peripheral nervous system; it can reduce or even eliminate pain-related aberrant firing of nerves. Spinal cord stimulation (SCS) involves the placement of long, multi-contact leads in the epidural space in the spine to modulate pain signaling in the spinal cord. In peripheral nerve stimulation (PNS), smaller, more compact stimulating electrodes are placed adjacent to peripheral nerves. Most commercially available PNS devices utilize an external wearable that powers the device and provides electrical impulses to the implanted lead. Traditional PNS systems initially implanted in the 1960s were large, cumbersome, and fraught with complications like lead fracture, migration, and erosion. PNS has evolved from an open surgical procedure to a percutaneous, minimally invasive neuromodulation technique that effectively reduces pain and improves function in patients with chronic pain. Additionally, patients who receive peripheral nerve stimulation require less medication, on average, than those who do not. This can lead to improved quality of life and reduced disability. As our understanding of neuromodulation grows, this technique may become increasingly popular as a treatment for chronic pain.One of the most agonizing physical pains a person can experience is phantom limb pain (PLP). This occurs when an individual loses a limb but continues to feel sensation in the missing appendage. The pain can be sharp and shooting, or it can be a dull, throbbing ache. Physical therapy is often used to help retrain the brain and reduce pain signals. Desensitization techniques may also help to lessen the Scott G. Pritzlaff
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