What are the differences and the similarities between a SCS and PNS?

What are the differences and the similarities between a Spinal Cord Stimulator and a Peripheral Nerve Stimulator? 

Let's define what each device is

• SCS: “Spinal cord stimulation is a procedure that delivers low-level electrical signals to the spinal cord or to specific nerves to block pain signals from reaching the brain.”

• PNS: “A peripheral nerve stimulator, also known as a train-of-four monitor, is used to assess neuromuscular transmission when neuromuscular blocking agents (NMBAs) are given to block musculoskeletal activity.”

These FDA-approved electrotherapy devices are surgically implanted and used as treatments to provide pain management through mild electrical signals that send electrical pulses to mask the pain felt by certain receptors in the brain. The benefit of these devices is they require no opioids or other drugs and involve only minimally invasive surgical procedures. 

How are Spinal Cord Stimulators and Peripheral Nerve Stimulators similar?

• Both devices make use of small devices that administer a very mild electrical current to mask pain signals. Each of these surgically implanted electrotherapy devices are connected to one or more leads, where they are placed near nerve pathways that frequently carry pain signals. 
• Both devices are initially implemented on an outpatient trial basis and require the patient to use an external wearable stimulator device. This device is light in weight and about the size of a matchbox and allows the patient to adjust the level of stimulation and customize it as desired. Most trials last about 7 days in total. Upon successful trial completion, the device may be permanently implanted under the skin.
• Many patients experience a pain reduction of a t least 50% and this is considered a successful trial.

How are Spinal Cord Stimulators and Peripheral Nerve Stimulators different? 

• The major difference between Spinal Cord Stimulators and Peripheral Nerve Stimulators is the placement of the wire leads. SCS leads are always positioned near the spinal cord, in the epidural space, where pain signals are generated. PNS leads may be placed near peripheral nerves in different areas of the body, typically over the painful area (most common areas include knees, shoulders, cluneal nerves, hips, etc). 
• Both of these devices are generally not used together. 
• Furthermore, spinal cord stimulators are intended for chronic pain, whereas peripheral nerve stimulators may be used for pain which is chronic or acute. 

What is the surgical process of an SCS vs PNS?

• For both SCS and PNS, a local anesthetic is administered, and the pain management specialist guides the placement of the lead wires using fluoroscopy. The leads are inserted into either the spinal column or at the nerves through a needle. Once the leads are placed, in a SCS trial, the battery is connected and taped to the patients back and the representative with the company will then work with the patient to help program the device to the appropriate signals to help with pain improvement. Similarly, once the PNS wires are placed, the company's representative will work with the patient and help place the battery over the lead area to program the device. 
• Both devices send mild electrical signals from the stimulator to help block normal pain signals traveling through the nerve. 
• A permanent SCS may be placed if the patient receives greater than 50% relief. However, at pain care we strive for 75% or more pain relief! During a permanent placement, the wires are placed the same through a needle into the spinal column under fluoroscopy. The battery, also known as an IPG, is then placed in a fatty area where a pocket is made. This is done by making a very small incision, about 3 centimeters in length. There is about 6 weeks of down time with this to ensure well healing but the stimulator can be programmed and on as soon as 48 hours after placement. 
• The PNS leads are placed the same as the SCS leads but they are placed over the peripheral nerves. There is no implantable battery, the battery is external and can be worn on an as needed basis. 

What is the goal for a patient with an SCS or PNS? 

• Decrease/wean off narcotics.
• Improvement of quality of life. 
• Regaining happiness and hope for the future. 
• Increasing manageable amount of activities in day-to-day living. 

Why choose Pain Care to help with your chronic pain? 

At Pain Care, we understand that our patients are individuals. Our providers stay up to date with the latest research and technologies to best understand individual causes for chronic pain. Each patient is treated with a personalized approach to give them the best possible care. Dr. Galan, Dr. Chang, Dr. Pulido & Dr. Donner has many years of experience as a pain specialist managing chronic pain for the back, neck and body. Contact us today to make an appointment for a consultation with one of our top pain specialists at Pain Care.

Author

Casey & Mallory