Table 6.
ASPN Best Practices PNS Guidelines
| ASPN Best Practices PNS Guidelines | Level of Evidence | Grade |
|---|---|---|
| Head/Neck | ||
| Stimulation of occipital nerves may be offered to patients with chronic migraine headache when conservative treatments have failed. The average effect size for relief of migraine symptoms is modest to moderate. | I | B |
| There is insufficient evidence to recommend stimulation of supraorbital and infraorbital nerves for neuropathic craniofacial pain. | II-3 | C |
| Upper Extremities | ||
| PNS may offer modest and short-term pain relief, improved physical function, and better quality of life for chronic hemiplegic shoulder pain. | I | B |
| PNS for mononeuropathies of the upper extremity may be offered following a positive diagnostic ultrasound-guided nerve block of the targeted nerve and is associated with modest to moderate pain relief. | II-2 | B |
| Low Back/Trunk | ||
| Subcutaneous peripheral field stimulation and optimal medication management may offer moderate improvement in pain intensity for failed back surgery compared to optimal medication management alone. | I | B |
| There is evidence that PNS of lumbar medial branch nerves may improve pain intensity, physical function, and pain interference in patients with axial, mechanical low back pain. | II-2 | B |
| There is limited evidence that PNS may alleviate pain in neuropathic pain syndrome involving the trunk and back including radiculopathy and post-herpetic neuralgia. | III | C |
| Lower Extremities | ||
| PNS may be considered for lower extremity neuropathic pain following failure of conservative treatment options and is associated with modest pain relief. | I | B |
| PNS may be considered for lower extremity post-amputation pain following failure of conservative treatment options and is associated with modest to moderate pain relief. | I | B |
| Other Considerations | ||
| As a less-invasive modality compared to SCS therapy, PNS may be offered to patients with CRPS Type I or Type II, and may be associated with modest improvement in pain intensity and functional outcomes. However, high-quality evidence is limited and other neuromodulation interventions such as dorsal root ganglion SCS are recommended for CRPS. | III | C |
| PNS carries a low-to-intermediate risk for bleeding complications and depends on the proximity of the targeted nerve to critical vessels and invasiveness of PNS implantation. | III | I |