Peripheral nerve stimulation: black, white and shades of grey

Unbearable chronic neuropathic pain, which can often not be resolved by conservative pain management techniques, calls for peripheral nerve stimulation. The technique, based on the Gate control hypothesis, uses low intensity current to block depolarization and conduction of neuronal membrane. Conditions such as intractable migraine, occipital and trigeminal neuralgia, burn injury pain, transformed migraine, among others, which cause intense pain can be treated by PNS, especially when the pain is localised and can be traced back to a specific nerve. Complication rates in PNS vary from 5% in some cases to 43% in others. Common complications include lead breakage, electrode migration, etc., meanwhile complications associated with every surgery like risks of anaesthesia, bleeding etc., are also present. PNS shows great potential in the treatment of intractable pain, and with its less invasiveness, high success rate, and development of advanced technologies like BION and SAINT, it is bound to become a standard procedure in the future for neuropathic pain management.