Background: Relief of regional, non-appendicular pain, particularly low back pain, through
spinal cord stimulation (SCS) has proven challenging. Recently, peripheral nerve stimulation
(PNS), also known as peripheral nerve field stimulation (PNFS) depending on the stimulation
area, has demonstrated efficacy for the treatment of well-localized, small areas of pain involving
the abdomen, inguinal region, pelvis, face, occipital area, and low back. More widespread
application of peripheral nerve stimulation has been limited by its narrow field of coverage in a
larger group of patients with diffuse or poorly localized pain.
Objectives: To determine if cross talk (the creation of an electrical circuit and therefore electrical
stimulation between separate subcutaneously placed PNS leads [i.e. inter-lead stimulation]) was
clinically possible across large painful areas, assess the breadth of stimulation coverage via cross
talk, evaluate the clinical efficacy of peripheral nerve stimulation cross talk (PNSCT), and confirm
the existence of cross talk across a large area in a cadaveric model.
Study Design: Case series observational report and cadaveric experimentation.
Setting: A private, comprehensive interventional pain management practice with pain
medicine fellowship training in the United States.
Methods: Eighteen consecutive patients with non-appendicular, regional pain were included in
the study. Data collection for the implanted patients included the presence or absence of stimulation
between the PNS leads, stimulation tolerability, stimulation region, lead orientation, lead montage,
inter-lead distance, and pain relief from PNSCT compared to PNS without cross talk.
A cadaveric analysis was performed to determine the presence or absence of an electrical circuit
with 2 subcutaneously PNS leads to confirm or refute the existence of electrical stimulation from
on lead to the other within subcutaneous fat with the leads placed at a significant distance apart
from one another.
Results: All 18 patients experienced significant pain relief, reduction of pain medication, and
functional improvement. Cadaveric experimentation confirmed the presence of an electrical
circuit with PNS leads placed at a distance far apart from one another and verified that interlead stimulation (cross talk) does occur in subcutaneous fat over a great distance.
Limitations: This study was limited by its small sample size, and the short-term follow-up
after implantation.
Conclusions: The use of the PNSCT technique allows for significant analgesia for large painful
areas that have been poorly captured using traditional SCS techniques and not considered as an
option with the current application of peripheral nerve stimulation.
Key words: Peripheral nerve stimulation, peripheral nerve field stimulation, cross talk, spinal
cord stimulation, neuromodulation, low back pain, failed back surgery syndrome, abdominal
pain, neck pain, post herpetic neuralgia, occipital headaches
Psychological measures and their influence on outcome parameters of peripheral nerve field stimulation in patients with chronic low back pain
