Evolving Standards in Neuromodulation: The Role of Peripheral Nerve Stimulation in Chronic Pain Management

The American Society of Pain and Neuroscience (ASPN guidelines) now endorse peripheral nerve stimulation (PNS) for chronic pain across multiple body regions, reframing PNS as a guideline-recommended, evidence-backed option that improves function and may reduce opioid use.

Rather than extending conservative therapy or defaulting to opioids, the consensus supports earlier consideration of PNS. Randomized controlled trials and pragmatic studies show significant, durable pain reduction, better mobility and sleep, and trends toward opioid-sparing—outcomes measured with patient-centered endpoints and consistent trial signals.

The guidelines also press for broader payer coverage, highlighting the cost-effectiveness of PNS and its potential to lower downstream opioid use and healthcare utilization. They specifically prioritize reimbursement pathways for 60-day PNS systems as a way to expand access and identify responders without committing to permanent implants.

Synthesis of device-focused RCTs and registry data identifies short-term systems, including the SPRINT PNS System, as clinically useful for low back, knee, shoulder, and post-amputation pain when delivered as an up-to-60-day course. Trial populations typically had focal, refractory pain after conservative measures; reported results include clinically meaningful pain score reductions, functional gains, and favorable safety profiles—supporting short-term PNS as a reversible, time-limited neuromodulation strategy to guide further care.