Peripheral Nerve Stimulation for Intractable Chronic Pain: Real-World Clinical Outcomes, Utilization, and Economic...

Chronic pain imposes a substantial clinical and economic burden, as many patients undergo repeated procedures and high-risk opioids without durable relief, driving persistent health care costs and resource utilization.

To evaluate whether established clinical outcomes can be replicated in real-world practice and to assess health care utilization and payer costs in a large cohort of patients treated with peripheral nerve stimulation (PNS).

Hybrid single-center retrospective study (n = 175) combined with national claims analysis (n = 953). A site coordinator collected data independently of the treating physician.

Single US center supplemented by national claims data.

One hundred and seventy-five adults with chronic neuropathic pain underwent a PNS trial. Those achieving ³ 50% pain relief were eligible for permanent implantation. Pain intensity was assessed with the Numeric Rating Scale (NRS-11) at baseline and up to 36 months post implant. Health care utilization and payer costs were derived from CPT-coded encounters one year pre- to two years post-implant, supported by national claims data, with appropriate statistical testing applied.

Of 175 patients, 163 (93%) achieved ≥ 50% pain relief during the trial, and 132 received permanent implants. Mean NRS-11 scores decreased from 7.2 ± 1.7 at baseline to approximately 1.7 ± 1.6 through 12 months, 1.4 ± 1.3 at 24 months, and 2.2 ± 1.8 at 36 months (all P < 0.001). No serious adverse events were reported. Pain center office visits decreased from 19.4 to 8.9 (54.1%) during months 0-12 (n = 103) and from 21.4 to 8.8 (58.9%) during months 13-24 (n = 50), with corresponding reductions in office-visit and pain management intervention costs (Wilcoxon z ≈ 2.8-7.6; all P < 0.001). National claims analyses showed similar facility-use trends. Cost reductions totaled $10,271 over 2 years, with projected 3-year savings of $17,110-$18,586. Of 103 patients with 12-month data, 91% reported high pain scores at baseline despite use of opioids. Ninety percent subsequently discontinued, reduced, or maintained stable medication use.

This analysis may be limited by coding variability, and differences between the EMR and claims datasets. Year-3 economic outcomes were projected from year-2 trends, though comparable patient characteristics support the relevance of the findings.

Permanent receiver-based PNS was associated with sustained pain reduction, no serious adverse events, and reduced health care utilization and costs in patients with chronic, intractable neuropathic pain of peripheral nerve origin. These findings support its clinical utility and potential economic value.