Peripheral nerve stimulator (PENS)


Peripheral nerve stimulation (PNS) is a type of neuromodulation that is used to treat chronic (long-term) pain. It uses electrical stimulation to stop certain nerves sending pain signals to the brain.

Peripheral nerve stimulation specifically targets peripheral nerves, which are nerves that are located beyond the brain or spinal cord.


Peripheral nerve stimulation is used to treat chronic pain that is not responding well enough to physiotherapy, painkillers or other medications. It is effective in conditions where the pain is caused by a single nerve, but has also been shown to work well in treating many other pain syndromes.

Occipital Neuralgia

Occipital neuralgia is one of the most severe forms of neuropathic (nerve) pain. It is often described as a throbbing pain which begins in the lower area of the neck and spreads to the scalp and forehead. It occurs when the occipital nerve that runs from the base of the skull becomes injured, inflamed or irritated.

PENS is a potentially ground breaking advance in the treatment of occipital neuralgia as it can be used to treat its severe symptoms of pain in an effective way without the use of strong medication or invasive surgery. Using PENS in the treatment of occipital neuralgia in an effective method without the use of strong medication or invasive surgery.

PENS is actually a fusion of the benefits of TENS (Transcutaneous Electrical Nerve Stimulation), with electro-acupuncture. In essence it harnesses the benefits of both into a very effective way of treating pain. TENS is a more familiar treatment, whereby electrical impulses, without needles are passed through the skin to treat the nerve endings and stop them from feeling pain. PENS is slightly different in the sense that the electrical impulses are delivered through the skin.

This fundamental difference in the two applications is that PENS can directly target the nerve endings that are causing the nerve pain. When a TENS procedure is used, the skin can often act as a barrier and some of the electrical stimulation is lost through the skin’s natural defenses, so a PENS system can get straight to the root of the problem and none of the potency of the electrodes is lost.

Genicular nerve neuropathy

Most people take their knees for granted. As long as they work properly, there’s no reason to think much about them. But, if a knee gets injured, begins to degenerate, or causes excruciating pain, they usually become the center of attention.

This outpatient procedure is an injection of anesthetic to the genicular nerves. These are the sensory nerves that transmit pain signals from the knee to the brain. Anesthetizing these nerves can disrupt the pain signals caused by degeneration of the knee. A genicular nerve block can provide temporary pain relief. It may help determine if a patient is a candidate for nerve ablation, which can provide long-term pain relief.

What are genicular nerves?

Your knee’s ability to feel and move comes from a complex network of nerves that feed into your knee. These nerves are called genicular nerves, and they include the superior medial, inferior medial, and superior lateral nerves. If any of these nerves get damaged or irritated, knee pain can result.

Peripheral nerve injection

With chronic pain, it can sometimes be difficult to know exactly what’s causing your pain, why you have it, and how to treat it. There are many, many possibilities, and often we start with one treatment plan and then move on to another. 

When we can get a definite, concrete answer to what is causing your pain, it’s a huge victory. Peripheral nerve injections can provide us with this information for some patients. 

What is a peripheral nerve injection?

A peripheral nerve injection is a diagnostic test that helps us determine if a specific peripheral nerve is the source of your pain. We call this procedure a peripheral nerve root block (PNRB). If it is successful in reducing your pain and improving symptoms, then we can identify the exact nerve that is the pain source.

Diagnostic peripheral nerve injections give us a concrete answer to what is causing your pain. With this knowledge, we can come up with and implement an appropriate and effective treatment plan.

But peripheral nerve injections go beyond being just a diagnostic tool. Most patients directly benefit from the procedure. We inject a local anesthetic and steroid that should decrease pain allowing you to complete daily activities much more easily. This may also provide the opportunity for physical therapy and light exercise to strengthen the back and other muscles.

After a peripheral nerve injection

In the days right after your injection, your pain may worsen to some extent. Don’t worry — this is normal. The local anesthetic will wear off and the injected medication will kick in about five days post-procedure. If you experience no pain reduction in the following weeks, your doctor will be able to conclude that the specific peripheral nerve targeted was not the pain source. At that point, we will discuss further options for testing and treatment.


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