Peripheral Nerve Field Stimulation in the Treatment of Persistent Low Back Pain: A Retrospective Study

Chronic low back pain (CLBP) is a common cause of disability, and many patients remain symptomatic despite medications, physiotherapy, or even spinal surgery. Response to conventional spinal cord stimulation for axial CLBP is variable. Peripheral nerve field stimulation (PNFS) delivers current through subcutaneous leads to generate broad paresthesia over painful regions. It has been shown to be effective for CLBP relief; however, its long-term efficacy remains uncertain.

We retrospectively reviewed adults with refractory axial CLBP who received PNFS at our center between 2011 and 2025 and who had >one-year follow-up. After a percutaneous trial, only responders (≥50% pain relief) proceeded to permanent implantation. Pain intensity, disability, quality of life (QoL), and psychologic status were evaluated at baseline, one year, and last follow-up using the Numeric Pain Rating Scale (NPRS), Oswestry Disability Index (ODI), Short Form-36 (SF-36), and Pain Catastrophizing Scale (PCS). Longitudinal changes were analyzed using generalized estimating equation models. Missing data were handled using multiple imputation with pooled estimates calculated according to Rubin's rules.

Overall, 36 patients (mean age 57.8 ± 13.0 years; 53% male) were observed for a mean of 8.0 ± 3.56 years. NPRS decreased by 2.6 points at 12 months (p = 0.003) and by 3.2 points at last follow-up (p = 0.0003), with stabilization beyond one year. The Brief Pain Inventory improved by 30.1 points at 12 months (p = 0.0002) and remained 24.1 points lower than baseline at final follow-up (p = 0.01). ODI decreased by 11.2 points at 12 months (p = 0.044), with sustained but nonsignificant long-term improvement. Significant gains were observed in SF-36 Bodily Pain and Social Functioning domains (p < 0.05). Total PCS decreased by 10.8 points at 12 months (p = 0.018). At final follow-up, 77.8% of patients reported ≥50% pain relief. Device-related complications occurred in 61% of patients, including 17% requiring revision surgery, with no infections or neurologic injuries.

Subcutaneous PNFS provided durable analgesia and functional improvement in this real-world cohort, with meaningful reductions in pain intensity and disability and improvements in QoL and catastrophizing. PNFS should be considered for patients with refractory axial CLBP and warrants further evaluation in prospective studies and in combination or comparison with spinal cord stimulation.