Longitudinal outcomes following temporary 60-day percutaneous peripheral nerve stimulation for chronic pain: a...

Percutaneous peripheral nerve stimulation (PNS) has emerged as a minimally invasive neuromodulation therapy for treating chronic pain, and additional real-world data continue to inform its effectiveness and safety in routine practice.

We conducted a retrospective cohort study of 125 patients who underwent temporary 60-day percutaneous PNS at Massachusetts General Hospital and Brigham and Women's Hospital between April 2021 and September 2025. The primary outcome was treatment response, defined as ≥30% reduction from day-of-procedure to median postprocedural Numerical Rating Scale (NRS) pain score, corresponding to clinically meaningful improvement per established consensus for chronic pain. Sensitivity analyses examined responder rates under alternative thresholds (≥50%) and postprocedure pain anchors (maximum NRS), including the combination of these. Secondary outcomes included change in opioid utilization (morphine milligram equivalents (MME)) and incidence of adverse events. Longitudinal pain trajectories were examined using linear mixed-effects models.

Of 125 patients, 102 had complete procedure-day and follow-up pain score data. Among these, 24 (24%) met the primary responder threshold of ≥30% reduction from day-of-procedure to median postprocedural NRS score. Sensitivity analyses yielded responder rates of 14 (14%) at the ≥50% threshold using median postprocedural NRS, 13 (13%) at the ≥30% threshold using maximum postprocedural NRS, and eight (8%) at the ≥50% threshold using maximum postprocedural NRS. For all patients, early PNS device removal occurred in 24 patients (19%): 11 (9%) due to lack of efficacy or worsening pain or new paresthesia and 13 (10%) for other reasons, including lead migration or dislodgement, lead fracture, removal to facilitate MRI, infection, and skin irritation; early removal was more frequent among non-responders than responders (22% vs 13%). Most patients were opioid-naïve at baseline; among the 35 patients (28%) with baseline opioid use, seven patients had a documentable change in MME at 1 year, five with an increase, and two with a decrease. For all patients, more than half (54%) carried at least one comorbid mental health diagnosis.

Patients with percutaneous 60-day PNS showed ≥30% pain reduction in 24% of patients using the primary outcome (median postprocedural NRS), with responder rates spanning 8%-14% across sensitivity analyses depending on the postprocedural pain anchor and threshold applied. Response rates fell short of those reported in indication-specific trials across all outcome definitions. Lead migration, dislodgement, or fracture were concentrated among non-responders and may represent a modifiable contributor to suboptimal outcomes. The high prevalence of mental health comorbidity in this population warrants prospective evaluation as a predictor of treatment response.