The guidelines provided by the New York State Workers Compensation Board offer fundamental principles for the utilization of peripheral nerve stimulation (PNS) for non-acute pain . These directives aim to assist healthcare professionals in the appropriate application of PNS techniques within the scope of comprehensive care.
Healthcare professionals with expertise in employing peripheral nerve stimulation can rely on the guidance outlined by the Workers Compensation Board to make well-informed decisions about the most suitable use of these techniques for their patients.
It is essential to emphasize that these principles are not intended to replace clinical judgment or professional expertise. The utilization of peripheral nerve stimulation should involve collaboration between the healthcare provider and the patient, considering individual factors such as pain management goals, suitability for the procedure, and potential risks associated with stimulation.
Peripheral Nerve Stimulation (PNS)
Procedure Pre-authorization:
- Before conducting this procedure, a provider must obtain pre-authorization.
- Pre-authorization requires an evaluation of the patient by a physician (MD or DO) who is adequately trained or experienced in using such devices. This typically involves a specialist in Physical Medicine, Pain Management, or Spine Surgery, in consultation with the primary treating physician or surgeon.
- The procedure itself must be performed by a physician who has documented training or experience as mentioned above.
Indication:
- Similar to spinal cord stimulation, a short-term trial or diagnostic block of the affected nerve may be necessary before implanting the device.
Note:
- This guideline excludes cranial nerves (e.g., vagus nerve, trigeminal nerve), gastric, sacral nerve, and/or posterior tibial nerve.
- Peripheral Nerve Stimulation (PNS) may be considered when:
- There is documented severe and persistent focal nerve pain within a defined neuronal distribution for at least three months.
- Multiple other treatment modalities, including but not limited to physical therapy, braces, medications, or surgery, have failed as clinically indicated.
- There are no surgical contraindications such as infections or medical risks.
- The patient has received appropriate education regarding risks and benefits.
- There are no active substance use issues or disorders.
- A mental health professional has conducted formal psychological screening and determined that the patient is a suitable candidate for the procedure.
