Current evidence on the efficacy of peripheral nerve-field stimulation (PNFS) for chronic low back pain is limited in both quantity and quality, and duration of follow-up is limited. Evidence on safety is also limited and there is a risk of complications from any implanted device. Therefore this procedure should only be used with special arrangements for clinical governance, consent and audit or research.
Clinicians wishing to undertake PNFS for chronic low back pain should take the following actions.
Inform the clinical governance leads in their Trusts.
Ensure that patients understand the uncertainty about the procedure's safety and efficacy and provide them with clear written information. In addition, the use of NICE's information for the public is recommended.
Patient selection for treatment using PNFS for chronic low back pain should be done by a multidisciplinary team, including specialists in pain management and neurosurgery.
Clinicians should enter details about all patients undergoing PNFS for chronic low back pain onto the UK Neuromodulation Register when it is available. They should audit and review clinical outcomes locally.
NICE encourages collaborative data collection and publication of comparative studies on PNFS for chronic low back pain. Outcomes should include measures of pain, function and quality of life, particularly in the long term. Full details of any complications and adjunctive or subsequent treatments should be recorded.