Focus of the Report: This report focuses on the use of peripheral nerve field stimulation (PNFS) to treat refractory chronic low back pain (CLBP).

Technology Description: Peripheral nerve field stimulation is a neuromodulation technology characterized by ease of implant with minimized risks compared with surgical procedures. To accomplish PNFS, a physician inserts 1 or more electronic leads into the subcutaneous tissue to directly stimulate the cutaneous afferents involved in the pain process. Rather than targeting a specific nerve, this therapy involves the stimulation of overlapping fields of multiple nerves and produces analgesia by reaching the spinal cord through corresponding sensory (afferent) nerves. Paresthesia, a mild tingling sensation or warmth, is induced, which reduces the patient’s perception of the underlying pain, bringing relief.

Controversy: Major controversies in the use of PNFS to treat CLBP include the durability of response and the optimization of the treatment schedule and electrode field arrangement. Appropriate patient selection criteria have not been defined beyond the presence of refractory CLBP that impedes individuals from performing daily acts of living, including gainful employment.

Key Questions:

  • Does PNFS alone or as an adjunct to other treatments reduce pain and increase functionality among adults with refractory CLBP of any etiology?

  • How does PNFS compare with other treatment modalities for CLBP in adults?

  • Is PNFS safe in the treatment of patients with CLBP of any etiology?

  • Have definitive patient selection criteria been established for the use of PNFS in the treatment of CLBP of any etiology?

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