Consensus Guidelines Published for Peripheral Nerve Stimulation in Neurologic Indications and Chronic Pain

A multidisciplinary expert panel convened by the American Society of Pain and Neuroscience has released updated consensus guidelines on the use of peripheral nerve stimulation (PNS) for chronic pain and selected neurologic indications. The guidelines were published in an article in the Journal of Pain Research, which reviewed evidence across nerve targets and clinical conditions, providing graded, evidence-based recommendations intended to guide clinical practice, patient selection, imaging approaches, device choice, and perioperative management. The authors of the guidelines concluded that overall evidence for PNS is strong across a wide spectrum of pain indications, supported by randomized trials and large retrospective studies.

In developing these guidelines, the expert panel used a structured literature review across Medline, EMBASE, and PubMed, applying US Preventive Services Task Force (USPSTF) grading criteria to evaluate randomized controlled trials, cohort studies, case series systematic reviews, meta-analyses, and expert consensus. The goal of this process was to create a comprehensive resource for clinicians and payors outlining the appropriateness, safety, and efficacy of PNS, as well as practical considerations for areas including imaging guidance, device selection, coding, and postoperative care.

Key points from the published guidelines include the following:

• While multiple proposed pathways exist, the definitive mechanism of action for PNS has not yet been established.
• Level 1 evidence supports PNS for multiple pain indication including but not limited to medial branch targets, lower back pain, pain in the foot and ankle, knee pain, and postamputation pain
• Level 1 evidence supports applications for PNS in reducing postoperative pain scores and opioid use in several surgical settings.
• Level 1 evidence supports PNS for urologic dysfunction, sleep apnea (phrenic/hypoglossal nerves), poststroke foot drop, restless legs syndrome, and chronic tic disorder.
• The recommendations also address infection prevention, lead choice, and multilayer closure to reduce migration and erosion.

Source: Latif U, Moghim R, Valimahomed A, 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. J Pain Res. 2025;18:5949-5990. Published 2025 Nov 7. doi:10.2147/JPR.S537222