Patient guide · Gabriel Radu, DO · Physical Medicine & Rehabilitation · Pain Management

Peripheral nerve stimulation

Peripheral nerve stimulation places a hair-thin wire next to one specific nerve outside the spine, in the shoulder, back, knee, foot, or elsewhere, to calm the pain signals coming from it. As with spinal cord stimulation, you try it temporarily before deciding on anything permanent.

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What is peripheral nerve stimulation?

Peripheral nerves are the nerves outside the spine. They run through your shoulders, arms, back muscles, hips, legs, and feet. When one of them keeps sending pain signals long after an injury or surgery has healed, a peripheral nerve stimulator (PNS) can help quiet it. A very thin wire, called a lead, is placed next to that nerve. It delivers mild electrical pulses that interfere with the pain signal before it reaches the spinal cord and brain.

PNS is more targeted than a spinal cord stimulator. It treats one nerve or one area rather than a whole region of the body. The leads stay outside the spine, so spine-specific risks such as spinal fluid leaks don’t apply.

There is more than one kind of PNS system

  • Wearable-powered systems: a tiny implanted receiver with no internal battery, powered through the skin by a disc you wear. This is the type shown in the illustration below.
  • Fully implanted systems: a small battery sits under the skin, similar to a spinal cord stimulator.
  • Temporary systems: a lead is used for a set treatment period, often about 60 days, and then removed completely.[4]

Your physician will explain which type is being recommended for you and why.

Is PNS right for me?

PNS is generally considered for severe, long-lasting pain that comes from a specific peripheral nerve, after standard treatments such as physical therapy, medicines, and injections have not given enough relief. One commonly used system is FDA-cleared for “severe intractable chronic pain of peripheral nerve origin”. It is not intended for the head or face.[5]

Often considered for

  • Nerve pain that remains after surgery or injury, including around a joint such as the knee or shoulder
  • Chronic pain in one area of the low back, shoulder, knee, or foot and ankle[3]
  • A pinched or scarred nerve that has not responded to other care
  • Pain in a clear nerve pattern (burning, shooting, electric, or hypersensitive to touch)
  • People who got strong but short-lived relief from a diagnostic nerve block. That result helps confirm which nerve to target.

May not be a good fit if you have

  • Widespread pain in many parts of the body
  • Skin infection or a skin condition where the device would go
  • A bleeding problem, or blood thinners that cannot safely be paused
  • Pregnancy
  • Trouble wearing, charging, or using the device consistently
  • A problem that surgery or another treatment should address first

How it works

3D view of the knee through translucent skin showing a thin lead beside a small nerve below the kneecap, a tiny implanted receiver, and a wearable disc lifted off its adhesive clip
Knee seen from the front and inside, through see-through skin. The wearable disc is shown lifted off its clip so you can see what lies beneath. Nothing with a battery is implanted in this design.
  1. 1Therapy disc: the wearable battery and controller
  2. 2Adhesive clip on the skin that the disc snaps onto
  3. 3Tiny implanted receiver (micro pulse generator) just under the skin
  4. 4Thin lead with electrical contacts lying beside the nerve
  5. 5Target nerve. Here it is the infrapatellar branch of the saphenous nerve, a common source of pain around the knee.
  6. 6Kneecap (patella)

You wear the disc when you want stimulation and can take it off for swimming, showering, or close-fitting clothes. These systems usually come with two discs, so one charges while you wear the other.

Where it is used

Front and back 3D skeletons with numbered markers at the shoulder, elbow, knee, ankle, low back, and hip
Common treatment areas. The COMFORT study of a wearable-powered system focused on the low back, shoulder, knee, and foot and ankle.[3] Your physician picks the exact spot based on which nerve is involved.
  1. 1Shoulder
  2. 2Arm and elbow
  3. 3Knee
  4. 4Foot and ankle
  5. 5Low back
  6. 6Buttock and hip

Step by step

  1. Evaluation

    An exam and review of your imaging and past treatments. Often a diagnostic nerve block (a numbing injection) is used to confirm that the target nerve is causing your pain.

  2. Wear test (some programs)

    Before anything is placed, you may wear a non-working disc and adhesive for several days. This checks whether the position is comfortable with your clothing, sleep, and work.

  3. Trial placement

    Through a needle, and guided by ultrasound or X-ray, a temporary lead is placed next to the nerve under local numbing, sometimes with light sedation. It connects to an external stimulator. For one system, FDA labeling limits trial devices to 30 days or less.[5]

  4. Trial period

    Use it during normal life and keep the diary. As with spinal cord stimulation, the usual target is at least 50% less pain along with better activity and sleep.[3]

  5. Permanent placement

    If the trial helps, a minimally invasive outpatient procedure places one or two leads and the small implanted receiver or battery. You are shown how to use the app or remote.

  6. Tune-ups and rehab

    Follow-up visits adjust the settings. Keep up your exercise program. As pain eases, it is the best time to rebuild strength and movement.

During the trial

Do

  • Use the stimulator during normal activities and try the things pain has stopped you doing
  • Rate your pain 2–3 times a day in the diary
  • Keep the dressing clean and dry
  • Check the skin under any adhesive each day
  • Call with questions or if the stimulation changes suddenly

Avoid

  • Getting the trial dressing wet unless you have been told it is OK
  • Strenuous or repetitive movement of the treated area, which can shift the lead
  • Pulling on the external wire or changing the dressing yourself
  • Hot tubs, pools, and baths during the trial

Living with a PNS system

Showers, swimming, and clothing

With a wearable-powered system, you take the disc off for water and tight clothing, and put it back on the clip afterward. Fully implanted systems have no external part once healed.

Charging

Wearable discs are swapped and recharged. Fully implanted batteries may need recharging through the skin, or replacement after some years. Ask how often your system needs attention.

MRI scans

Several PNS systems are labeled “MR Conditional”, which means an MRI is possible only under specific conditions. Always tell the MRI team and carry your device card.

Airport security, other devices, diathermy

Carry your device card for security screening. Tell every clinician you have a stimulator. Pacemakers and defibrillators need coordination between teams, and deep-heat therapy (diathermy) should be avoided unless your device labeling says otherwise.

What the research shows

The largest randomized trial of a wearable-powered PNS system is the COMFORT study. Patients with chronic nerve pain in the low back, shoulder, knee, or foot and ankle were assigned to PNS plus usual care or usual care alone.[1],[3]

84%vs 3%

At 3 months

had at least 50% less pain with PNS, compared with 3% on usual care alone. Average pain fell 67% with PNS versus 6% without.

Hatheway 2025[1]
87%at 12 months

Relief held up at one year

of PNS patients were still responders at 12 months, with a 69% average pain reduction. The study continues to 3 years.

Hatheway 2026[2]
81%

Comfort of the wearable

of patients found the external disc comfortable to wear. No serious device-related adverse effects were reported through 12 months.

Hatheway 2025, 2026[1],[2]
Expertguidance

National consensus guideline

A multidisciplinary panel from the American Society of Pain and Neuroscience reviewed the evidence and issued graded recommendations for when PNS should be used.

Latif 2025[4]

How to read these results

COMFORT was paid for by the device manufacturer. It was not blinded: the comparison group knew they were not receiving a device, and no sham device was used. Only people who passed the trial went on to a permanent implant. Results beyond one year are still being collected. These are encouraging numbers for carefully selected patients, not a guarantee.

Risks and side effects

Serious complications are uncommon. The most frequent problems are related to the hardware.[6]

Call your care team right away if you have

  • Fever over 101°F (38.3°C), or chills
  • Redness, warmth, swelling, or drainage at the lead or implant site
  • A rash or blistering under the adhesive that is getting worse
  • New numbness or weakness in the treated limb
  • Stimulation that suddenly becomes painful. Remove the disc or turn it off, then call.

Questions to bring to your visit

Trial diary

Rate your pain from 0 (none) to 10 (worst imaginable). Note the program or setting you used.

DayPain (morning)Pain (evening) Activities I triedHours sleptPain medicine takenSetting / notes
Before
1
2
3
4
5
6
7

References

  1. Hatheway J, et al. Clinical study of a micro-implantable pulse generator for the treatment of peripheral neuropathic pain: 3-month and 6-month results from the COMFORT randomised controlled trial. Regional Anesthesia & Pain Medicine. 2025;50:561-567. Sponsored by the device manufacturer. doi.org/10.1136/rapm-2023-105264
  2. Hatheway J, et al. Clinical study of a micro-implantable pulse generator for the treatment of peripheral neuropathic pain: 12-month results from the COMFORT randomized controlled trial. Regional Anesthesia & Pain Medicine. 2026;51:278-284. Sponsored by the device manufacturer. doi.org/10.1136/rapm-2024-106099
  3. Hatheway J, et al. Design of a multicenter, randomized controlled trial for the treatment of peripheral neuropathic pain (COMFORT study) with a micro-implantable pulse generator. Journal of Pain Research. 2024;17:2891-2901. doi.org/10.2147/JPR.S460563
  4. Latif U, et al. Consensus guidelines for the use of peripheral nerve stimulation in the treatment of chronic pain and neurological diseases: a NEURON project from the American Society of Pain and Neuroscience. Journal of Pain Research. 2025;18:5949-5990. doi.org/10.2147/JPR.S537222
  5. U.S. Food and Drug Administration. 510(k) K232415, Nalu Neurostimulation System: indications for use (peripheral nerve stimulation), August 2024. www.accessdata.fda.gov/cdrh_docs/pdf23/K232415.pdf
  6. Eldabe S, Buchser E, Duarte RV. Complications of spinal cord stimulation and peripheral nerve stimulation techniques: a review of the literature. Pain Medicine. 2016;17:325-336. doi.org/10.1093/pm/pnv025

Related guides

Spinal cord stimulator trialStimulation over the spinal cord for wider back and leg pain. Basivertebral nerve ablationA one-time, implant-free treatment for one specific type of low back pain. Conditions and exercisesUnderstand your diagnosis and build your home program.

About this page. This guide is general education written for patients. It does not replace advice from your own doctor, and results differ from person to person. Numbers quoted come from the published studies listed in the references; many large device studies are funded by the companies that make the devices, which we note where it applies.

Brand names that appear here are trademarks of their owners. This page is independent: it was not produced, paid for, or reviewed by any device manufacturer.

3D illustrations were rendered for this site from the open anatomy models of Z-Anatomy and BodyParts3D (© The Database Center for Life Science, CC BY-SA 2.1 JP; Z-Anatomy, CC BY-SA 4.0). Device hardware is a generic representation, not any specific product. The illustrations are shared under CC BY-SA 4.0.

Last reviewed: September 2026. If you have urgent symptoms, call your care team or 911.