DESCRIPTION
Peripheral subcutaneous field stimulation (PSFS) is a form of neuromodulation intended to treat chronic neuropathic pain. Applications of PSFS being evaluated are craniofacial stimulation for headache and migraine, craniofacial pain, or occipital neuralgia. PSFS is also being investigated for low back, neck, and shoulder pain, inguinal and pelvic pain, thoracic pain, abdominal pain, fibromyalgia and postherpetic neuralgia. With this method, leads are placed subcutaneously within the area of maximal pain with the objective of stimulating the region of affected nerves, cutaneous afferents or the dermatomal distribution of the nerves, which then converge back on the spinal cord. The mechanism of action in PSFS is unknown. There are no FDA devices approved for this use. PSFS is an off-label use of spinal cord stimulation devices that have been FDA approved.
POLICY
Peripheral subcutaneous field stimulation is considered investigational.
IMPORTANT REMINDERS
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ADDITIONAL INFORMATION
Prospective controlled trials comparing peripheral subcutaneous field stimulation with placebo or alternative treatment modalities are needed to determine the efficacy of this treatment for chronic pain. Currently the evidence is insufficient to determine the effects of the technology on health outcomes.
SOURCES
BlueCross BlueShield Association. Evidence Positioning System. (5:2022). Peripheral subcutaneous field stimulation (7.01.139). Retrieved April 7, 2023 from https://www.evidencepositioningsystem.com/. (9 articles and/ or guidelines reviewed)
Eldabe, S., Taylor, R., Goossens, S., Bouche, B., Gültuna, I., Green, C., et al. (2018). A randomized controlled trial of subcutaneous nerve stimulation for back pain due to failed back surgery syndrome: the SubQStim study. Neuromodulation, 22 (5), 519-528. (Level 2 evidence)
Hofmeister, M., Memedovich, A., Brown, S., Saini, M., Dowsett, L.E., Lorenzetti, D.L., et al. (2020). Effectiveness of neurostimulation technologies for the management of chronic pain: A systematic review. Neuromodulation: Journal of the Neuromodulation Society, 23 (2), 150-157. Abstract retrieved February 11, 2021 from PubMed database.
Kloimstein, H., Likar, R., Kern, M., Neuhold, J., Cada, M., Loning, N., et al. (2014). Peripheral nerve field stimulation (PNFS) in chronic low back pain: a prospective multicenter study. Neuromodulation, 17 (2), 180-187. Abstract retrieved May 21, 2018 from PubMed database.
National Institute for Health and Care Excellence. (2013, March). Interventional procedural guidance: Peripheral nerve-field stimulation for chronic low back pain. Retrieved April 30, 2013 http://www.nice.org.uk.
Verrills, P., Rose, R., Mitchell, B., Vivian, D., & Barnard, A. (2014). Peripheral nerve field stimulation for chronic headache: 60 cases and long-term follow-up. Neuromodulation, 17 (1), 54-59. Abstract retrieved May 21, 2018 from PubMed database.
Winifred S. Hayes, Inc. Medical Technology Directory. (2021, April; last update search March 2023). Peripheral Nerve Field Stimulation for Treatment of Chronic Low Back Pain. Retrieved April 7, 2023 from www.hayesinc.com/subscribers. (31 articles and/or guidelines reviewed)
ORIGINAL EFFECTIVE DATE: 3/1980
MOST RECENT REVIEW DATE: 5/11/2023
ID_BA
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