J Neurol Surg A Cent Eur Neurosurg 2016; 77(01): 063-067
DOI: 10.1055/s-0035-1547362
Consensus Statement
Georg Thieme Verlag KG Stuttgart · New York

Subcutaneous Peripheral Nerve Field Stimulation for the Treatment of Chronic Back Pain: Patient Selection and Technical Aspects

Matthias Winkelmueller*
1   Department of Neurosurgery, Diakonie Hospital Friederikenstift, Hannover, Germany
Malgorzata Anna Kolodziej*
2   Department of Neurosurgery, UKGM University of Giessen, Giessen, Germany
Wolfgang Welke
3   Department of Anesthesiology and Pain Unit, Hospital Iserlohn, Iserlohn, Germany
Athanasios Koulousakis
4   Department of Stereotactic and Functional Neurosurgery, University of Cologne, Cologne, Germany
Ramon Martinez
5   Department of Neurosurgery, UMG University of Goettingen, Göttingen, Germany
› Author Affiliations
Further Information

Publication History

07 July 2014

14 November 2014

Publication Date:
27 July 2015 (online)


A wide variety of therapeutic options are available for the treatment of chronic back pain, a very common condition in Western countries with high related social and economic costs. Nevertheless, it is not always possible to achieve adequate long-term pain relief in spite of intensive analgesic therapies. Subcutaneous peripheral nerve field stimulation (sPNFS) is a newly approved neuromodulative treatment for back pain. In previously reported case series, it has provided encouraging results on long-term pain relief, improvement in quality of life, and a reduced need for analgesic drugs. Although the surgical technique is simple, there is neither consensus for patient management nor a standardized procedure for the implantation procedure. After consideration of our personal experience and the published literature, a basic recommendation has now been developed. This represents the first step toward planning prospective studies and standardization of this treatment and will permit comparison of this technique and the results with sPNFS.

* Both the authors contributed equally to this article.

  • References

  • 1 Bevan S. The impact of back pain on sickness absence in Europe. The Work Foundation Web site. http://www.theworkfoundation.com/DownloadPublication/Report/313
  • 2 Frettlöh J, Maier C, Gockel H, Zenz M, Hüppe M. Characterization of chronic pain patients in German pain centers: core data from more than 10,000 patients [in German]. Schmerz 2009; 23 (6) 576-591
  • 3 Berger A, Dukes EM, Oster G. Clinical characteristics and economic costs of patients with painful neuropathic disorders. J Pain 2004; 5 (3) 143-149
  • 4 Meyer-Rosberg K, Burckhardt CS, Huizar K, Kvarnström A, Nordfors LO, Kristofferson A. A comparison of the SF-36 and Nottingham Health Profile in patients with chronic neuropathic pain. Eur J Pain 2001; 5 (4) 391-403
  • 5 Kumar K, Taylor RS, Jacques L , et al. The effects of spinal cord stimulation in neuropathic pain are sustained: a 24-month follow-up of the prospective randomized controlled multicenter trial of the effectiveness of spinal cord stimulation. Neurosurgery 2008; 63 (4) 762-770 ; discussion 770
  • 6 Meglio M, Cioni B, Visocchi M, Tancredi A, Pentimalli L. Spinal cord stimulation in low back and leg pain. Stereotact Funct Neurosurg 1994; 62 (1–4) 263-266
  • 7 Slavin KV, Nersesyan H, Wess C. Peripheral neurostimulation for treatment of intractable occipital neuralgia. Neurosurgery 2006; 58 (1) 112-119 ; discussion 112–119
  • 8 Stinson Jr LW, Roderer GT, Cross NE, Davis BE. Peripheral subcutaneous electrostimulation for control of intractable post-operative inguinal pain: a case report series. Neuromodulation 2001; 4 (3) 99-104
  • 9 Al Tamimi M, Davids HR, Barolat G, Krutsch J, Ford T. Subcutaneous peripheral nerve stimulation treatment for chronic pelvic pain. Neuromodulation 2008; 11 (4) 277-281
  • 10 Krutsch JP, McCeney MH, Barolat G, Al Tamimi M, Smolenski A. A case report of subcutaneous peripheral nerve stimulation for the treatment of axial back pain associated with postlaminectomy syndrome. Neuromodulation 2008; 11 (2) 112-115
  • 11 Reverberi C, Bonezzi C, Demartini L. Peripheral subcutaneous neurostimulation in the management of neuropathic pain: five case reports. Neuromodulation 2009; 12 (2) 146-155
  • 12 Verrills P, Vivian D, Mitchell B, Barnard A. Peripheral nerve field stimulation for chronic pain: 100 cases and review of the literature. Pain Med 2011; 12 (9) 1395-1405
  • 13 Sator-Katzenschlager S, Fiala K, Kress HG , et al. Subcutaneous target stimulation (STS) in chronic noncancer pain: a nationwide retrospective study. Pain Pract 2010; 10 (4) 279-286
  • 14 McRoberts WP, Wolkowitz R, Meyer DJ , et al. Peripheral nerve field stimulation for the management of localized chronic intractable back pain: results from a randomized controlled study. Neuromodulation 2013; 16 (6) 565-574 ; discussion 574–575
  • 15 Hamm-Faber TE, Aukes HA, de Loos F, Gültuna I. Subcutaneous stimulation as an additional therapy to spinal cord stimulation for the treatment of lower limb pain and/or back pain: a feasibility study. Neuromodulation 2012; 15 (2) 108-116 ; discussion 116–117
  • 16 Yakovlev AE, Resch BE, Yakovleva VE. Peripheral nerve field stimulation in the treatment of postlaminectomy syndrome after multilevel spinal surgeries. Neuromodulation 2011; 14 (6) 534-538 ; discussion 538
  • 17 Verrills P, Mitchell B, Vivian D , et al. Peripheral nerve stimulation: a treatment for chronic low back pain and failed back surgery syndrome? . Neuromodulation 2009; 12: 68-75
  • 18 Tronnier V, Baron R, Birklein F , et al; Arbeitsgruppe zur Erstellung der S3-Leitlinie. Epidurale Rückenmarkstimulation zur Therapie chronischer Schmerzen. Zusammenfassung der S3-Leitlinie [Epidural spinal cord stimulation for therapy of chronic pain. Summary of the S3 guidelines]. Schmerz 2011; 25 (5) 484-492
  • 19 Bernstein CA, Paicius RM, Barkow SH, Lempert-Cohen C. Spinal cord stimulation in conjunction with peripheral nerve field stimulation for the treatment of low back and leg pain: a case series. Neuromodulation 2008; 11 (2) 116-123
  • 20 Spruce L. Back to basics: preventing surgical site infections. AORN J 2014; 99 (5) 600-608 ; quiz 609–611
  • 21 Sharma MS, Vohra A, Thomas P , et al. Effect of risk-stratified, protocol-based perioperative chemoprophylaxis on nosocomial infection rates in a series of 31 927 consecutive neurosurgical procedures (1994–2006). Neurosurgery 2009; 64 (6) 1123-1130 ; discussion 1130–1131
  • 22 Mironer YE, Hutcheson JK, Satterthwaite JR , et al. Prospective, two-part study of the interaction between spinal cord stimulation and peripheral nerve field stimulation in patients with low back pain: development of a new spinal-peripheral neurostimulation method. Neuromodulation 2011; 14: 151-155
  • 23 Lipov EG. ‘Hybrid neurostimulator’: simultaneous use of spinal cord and peripheral nerve field stimulation to treat low back and leg pain. Prog Neurol Surg 2011; 24: 147-155
  • 24 Burgher AH, Huntoon MA, Turley TW, Doust MW, Stearns LJ. Subcutaneous peripheral nerve stimulation with inter-lead stimulation for axial neck and low back pain: case series and review of the literature. Neuromodulation 2012; 15 (2) 100-106 ; discussion 106–107
  • 25 Falco FJ, Berger J, Vrable A, Onyewu O, Zhu J. Cross talk: a new method for peripheral nerve stimulation. An observational report with cadaveric verification. Pain Physician 2009; 12 (6) 965-983
  • 26 Navarro RM, Vercimak DC. Triangular stimulation method utilizing combination spinal cord stimulation with peripheral subcutaneous field stimulation for chronic pain patients: a retrospective study. Neuromodulation 2012; 15 (2) 124-131
  • 27 Reverberi C, Dario A, Barolat G. Spinal cord stimulation (SCS) in conjunction with peripheral nerve field stimulation (PNfS) for the treatment of complex pain in failed back surgery syndrome (FBSS). Neuromodulation 2013; 16 (1) 78-82 ; discussion 83
  • 28 Kloimstein H, Likar R, Kern M , et al. Peripheral nerve field stimulation (PNFS) in chronic low back pain: a prospective multicenter study. Neuromodulation 2014; 17 (2) 180-187
  • 29 de Vos CC, Dijkstra C, Lenders MW, Holsheimer J. Spinal cord stimulation with hybrid lead relieves pain in low back and legs. Neuromodulation 2012; 15 (2) 118-123 ; discussion 123
  • 30 Schu S, Slotty PJ, Bara G, von Knop M, Edgar D, Vesper J. A prospective, randomised, double-blind, placebo-controlled study to examine the effectiveness of burst spinal cord stimulation patterns for the treatment of failed back surgery syndrome. Neuromodulation 2014; 17 (5) 443-450
  • 31 Song JJ, Popescu A, Bell RL. Present and potential use of spinal cord stimulation to control chronic pain. Pain Physician 2014; 17 (3) 235-246
  • 32 Mørch CD, Nguyen GP, Wacnik PW, Andersen OK. Mathematical model of nerve fiber activation during low back peripheral nerve field stimulation: analysis of electrode implant depth. Neuromodulation 2014; 17 (3) 218-225 ; discussion 225
  • 33 Eldabe S, Kern M, Peul W, Green C, Winterfeldt K, Taylor RS. Assessing the effectiveness and cost effectiveness of subcutaneous nerve stimulation in patients with predominant back pain due to failed back surgery syndrome (SubQStim study): study protocol for a multicenter randomized controlled trial. Trials 2013; 14: 189