Consensus Guidelines from the American Society of Pain and Neuroscience for the Use of 60-Day Peripheral Nerve Stimulation Therapy. A NEURON Living Guideline Project

doi:10.2147/JPR.S521788

. 2025 Jun 24:18:3117-3139.

doi: 10.2147/JPR.S521788. eCollection 2025.

Consensus Guidelines from the American Society of Pain and Neuroscience for the Use of 60-Day Peripheral Nerve Stimulation Therapy. A NEURON Living Guideline Project

Benjamin Gill¹, Cody Tidwell², Jonathan M Hagedorn³, Alexandra M Moreira⁴, Marco Lawandy⁵, Benjamin Boyett⁶, Justin Schappell⁷, Usman Latif⁸, Scott Pritzlaff⁹, Ioannis Skaribas¹⁰, Hemant Kalia¹¹, Samir Sheth¹², Maricela Schnur¹³, Sean Li¹⁴, Denise Lester^{15

16}, Trevor Ellico¹⁷, Ramana Naidu¹⁸, David Russo¹⁹, Christopher Massey²⁰, Einar Ottestad²¹, Kevin Vorenkamp²², Henry Vucetic²³, Matthew J Pingree³, David Abejón²⁴, Mehul J Desai²⁵, David Dickerson^{26

27}, Amitabh Gulati²⁸, Dawood Sayed⁸, Timothy R Deer²⁹

Affiliations

¹ Omaha Pain Physicians, Omaha, NE, USA.
² Department of Anesthesiology and Pain Medicine, University of Minnesota, Minneapolis, MN, USA.
³ Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA.
⁴ Department of Anesthesiology and Pain Medicine, Rush University, Chicago, IL, USA.
⁵ Department of Physical Medicine and Rehabilitation, Montefiore Medical Center, Bronx, NY, USA.
⁶ Department of Physical Medicine and Rehabilitation, University of Missouri, Columbia, MO, USA.
⁷ Department of Pain Medicine, Mayo Clinic Health System, Eau Claire, WI, USA.
⁸ Department of Anesthesiology and Pain Medicine, The University of Kansas Health System, Kansas City, KS, USA.
⁹ Department of Anesthesiology and Pain Medicine, University of California-Davis, Sacramento, CA, USA.
¹⁰ Expert Pain, Houston, TX, USA.
¹¹ Center for Research & Innovation in Spine & Pain, Rochester, NY, USA.
¹² Sutter Health Systems, Roseville, CA, USA.
¹³ Department of Pain Medicine, Guthrie Clinic, Ithaca, NY, USA.
¹⁴ National Spine and Pain Centers, Shrewsbury, NJ, USA.
¹⁵ Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA.
¹⁶ Department of Physical Medicine and Rehabilitation, Richmond VA Medical Center, Richmond, VA, USA.
¹⁷ Department of Anesthesiology, University of Utah, Salt Lake City, UT, USA.
¹⁸ MarinHealth Spine Institute, UCSF Affiliate, Larkspur, CA, USA.
¹⁹ Columbia Pain Management, Hood River, OR, USA.
²⁰ Pain Specialists of America, Austin, TX, USA.
²¹ Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.
²² Duke University Department of Anesthesiology, Durham, NC, USA.
²³ University Hospitals Department of Anesthesiology and Perioperative Medicine, Cleveland, OH, USA.
²⁴ Unidad de Dolor, Hospital Universitario Quironsalud Madrid, Madrid, Spain.
²⁵ International Spine, Pain & Performance Center, Washington, DC, USA.
²⁶ Department of Anesthesiology, Critical Care & Pain Medicine, Endeavor Health, Evanston, IL, USA.
²⁷ Department of Anesthesia & Critical Care, University of Chicago Pritzker School of Medicine, Chicago, IL, USA.
²⁸ Department of Anesthesiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
²⁹ The Spine and Nerve Center of the Virginias, Charleston, WV, USA.

PMID: 40590046
PMCID: PMC12206896
DOI: 10.2147/JPR.S521788

Consensus Guidelines from the American Society of Pain and Neuroscience for the Use of 60-Day Peripheral Nerve Stimulation Therapy. A NEURON Living Guideline Project

Benjamin Gill et al. J Pain Res. 2025.

. 2025 Jun 24:18:3117-3139.

doi: 10.2147/JPR.S521788. eCollection 2025.

Authors

Affiliations

¹ Omaha Pain Physicians, Omaha, NE, USA.
² Department of Anesthesiology and Pain Medicine, University of Minnesota, Minneapolis, MN, USA.
³ Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA.
⁴ Department of Anesthesiology and Pain Medicine, Rush University, Chicago, IL, USA.
⁵ Department of Physical Medicine and Rehabilitation, Montefiore Medical Center, Bronx, NY, USA.
⁶ Department of Physical Medicine and Rehabilitation, University of Missouri, Columbia, MO, USA.
⁷ Department of Pain Medicine, Mayo Clinic Health System, Eau Claire, WI, USA.
⁸ Department of Anesthesiology and Pain Medicine, The University of Kansas Health System, Kansas City, KS, USA.
⁹ Department of Anesthesiology and Pain Medicine, University of California-Davis, Sacramento, CA, USA.
¹⁰ Expert Pain, Houston, TX, USA.
¹¹ Center for Research & Innovation in Spine & Pain, Rochester, NY, USA.
¹² Sutter Health Systems, Roseville, CA, USA.
¹³ Department of Pain Medicine, Guthrie Clinic, Ithaca, NY, USA.
¹⁴ National Spine and Pain Centers, Shrewsbury, NJ, USA.
¹⁵ Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA.
¹⁶ Department of Physical Medicine and Rehabilitation, Richmond VA Medical Center, Richmond, VA, USA.
¹⁷ Department of Anesthesiology, University of Utah, Salt Lake City, UT, USA.
¹⁸ MarinHealth Spine Institute, UCSF Affiliate, Larkspur, CA, USA.
¹⁹ Columbia Pain Management, Hood River, OR, USA.
²⁰ Pain Specialists of America, Austin, TX, USA.
²¹ Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.
²² Duke University Department of Anesthesiology, Durham, NC, USA.
²³ University Hospitals Department of Anesthesiology and Perioperative Medicine, Cleveland, OH, USA.
²⁴ Unidad de Dolor, Hospital Universitario Quironsalud Madrid, Madrid, Spain.
²⁵ International Spine, Pain & Performance Center, Washington, DC, USA.
²⁶ Department of Anesthesiology, Critical Care & Pain Medicine, Endeavor Health, Evanston, IL, USA.
²⁷ Department of Anesthesia & Critical Care, University of Chicago Pritzker School of Medicine, Chicago, IL, USA.
²⁸ Department of Anesthesiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
²⁹ The Spine and Nerve Center of the Virginias, Charleston, WV, USA.

PMID: 40590046
PMCID: PMC12206896
DOI: 10.2147/JPR.S521788

Abstract

Peripheral nerve stimulation (PNS) has evolved with various applications and durations of therapy. In recent years, extensive data has been developed on a 60-day treatment using a novel approach. Confusion exists on the use of a trial therapy, a permanent implant, and a 60-day duration treatment. The American Society of Pain and Neuroscience (ASPN) seeks to clarify the literature associated with this neuromodulation approach. A diverse group of experts was nominated to provide opinions and guidance based on evidence-graded assessment and clinical knowledge. This guidance is the first to specifically assess the clinical use of 60-day PNS and best medical practice.

Keywords: best practices; clinical guidelines; pain medicine; peripheral nerve stimulation.

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Conflict of interest statement

Usman Latif: Consultant: Abbott, Brixton Biosciences, Hydrocision, Nalu Medical, Nevro, Omnia Medical, Saluda, Spinal Simplicity, SPR Therapeutics, Stryker, Vertos Medical, Vivex Biologics; Research funding: Mainstay Medical, Spinal Simplicity, Vivex Biologics; Stock: InFormed Consent, Spinal Simplicity. Scott Pritzlaff: Consultant SPR Therapeutics, Bioventus, Nalu Medical; Education grants from Abbott, Biotronik, Medtronic, and Nevro; Royalties from Wolters Kluwer. Ioannis Skaribas: Consultant Abbott, Nalu. Hemant Kalia: Consultant Abbott, Averitas, Nalu, Curonix, SPR Therapeutics, Nervonik, Virdio Health. Samir Sheth: Consultant SPR, Medtronic, Vertos, Boston Scientific, SI Bone; Royalties from Wolters Kluwer. Madi Schnur: Consultant SPR Therapeutics. Sean Li: Consultant Abbott, Avanos, Averitas Pharma, Boston Scientific, Biotronik, Medtronic, Nalu Medical, PainTeq, Presidio, Saluda, SPR Therapeutics, Stryker; Research funding Avanos, Averitas Pharma, Nevro, Presidio, SPR Therapeutics, Stock options NeuroOne, Nalu Medical. Denise Lester: the Primary Investigator for the RESET trial; Research funding from SPR Therapeutics. Ramana Naidu: Consultant Abbott, Avanos, Boston Scientific, Bioventus, Biotronik, Medtronic, Nalu Medical, Nervonik, SPR Therapeutics. Royalties from McGraw-Hill. David Russo: Consultant Nalu, Nevro. Einar Ottestad: Consultant for BioVentus, SPR Therapeutics, Coloplast; Stock options for Restera Medical; Co-founder Altamont Medical. Henry Vucetic: Consultant Abbott, SPR Therapeutics, Vertos, Saluda, Boston Scientific. David Abejón: Proctor Abbott, Medtronic, Boston Scientific, Cardiva, MBA, Saluda Medical. Mehul Desai: Consultant Medtronic, Nalu Medical Stock Options AllaiHealth, HypreVention, SPR Therapeutics, SynerFuse, Virdio Health, Royalties Oxford Medical. David Dickerson: Consultant SPR, Stryker, Nalu, Vertos, Vertex, Abbott, Biotronik; Research support Abbott, SPR. Amitabh Gulati: Consultant for SPR therapeutics, Nalu Medical, Medtronic, AIS healthcare, Neurovasis, Tersera Medical, Hinge Health, Menda Health, Veritas Pharma. Sayed Dawood: Stock Options Spr, Painteq, Mainstay; personal fees from Abbott, Saluda. Timothy Deer: consultant research Abbott, SpineThera, Saluda Medical, Cornerloc, Boston Scientific, personal fees, Pain Teq, Spinal Simplicity, Biotronik, Aurora, Nervonik, SPR Therapeutics, outside the submitted work; In addition, Dr Timothy Deer has a patent pending to Abbott. The other authors report no conflicts of interest in this work.

Figures

**Figure 1**
Responder Rates from Initiation of PNS Treatment. Reprinted with permission from Dove Medical Press. Naidu R, Li S, Desai MJ, Sheth S, Crosby ND, Boggs JW. 60-Day PNS Treatment May Improve Identification of Delayed Responders and Delayed Non-Responders to Neurostimulation for Pain Relief. *Journal of Pain Research*. 2022;15:733–743.

**Figure 2**
Pain Response to PNS in Post-Amputation Pain. Reprinted from Gilmore CA, Ilfeld BM, Rosenow JM et al. Percutaneous 60-day peripheral nerve stimulation implant provides sustained relief of chronic pain following amputation: 12-month follow-up of a randomized, double-blind, placebo-controlled trial. *Regional Anesthesia & Pain Medicine*. 2020;45(1):44–51. Creative Commons.

See this image and copyright information in PMC

References

1. Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965;150(3699):971–979. doi: 10.1126/science.150.3699.971 - DOI - PubMed
1. Wall PD, Sweet WH. Temporary abolition of pain in man. Science. 1967;155(3758):108–109. doi: 10.1126/science.155.3758.108 - DOI - PubMed
1. Deer TR, Levy RM, Verrills P, Mackey S, Abejon D. Perspective: peripheral nerve stimulation and peripheral nerve field stimulation birds of a different feather. Pain Med. 2015;16(3):411–412. doi: 10.1111/pme.12662 - DOI - PubMed
1. Strand N, D’Souza RS, Hagedorn JM, et al. Evidence-based clinical guidelines from the American society of pain and neuroscience for the use of implantable peripheral nerve stimulation in the treatment of chronic pain. J Pain Res. 2022;15:2483–2504. doi: 10.2147/JPR.S362204 - DOI - PMC - PubMed
1. Gildenberg PL. History of electrical neuromodulation for chronic pain. Pain Med. 2006;7(s1):S7–S13.

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- PubMed Central

[1] Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965;150(3699):971–979. doi: 10.1126/science.150.3699.971 - DOI - PubMed

[2] Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965;150(3699):971–979. doi: 10.1126/science.150.3699.971 - DOI - PubMed

[3] Wall PD, Sweet WH. Temporary abolition of pain in man. Science. 1967;155(3758):108–109. doi: 10.1126/science.155.3758.108 - DOI - PubMed

[4] Wall PD, Sweet WH. Temporary abolition of pain in man. Science. 1967;155(3758):108–109. doi: 10.1126/science.155.3758.108 - DOI - PubMed

[5] Deer TR, Levy RM, Verrills P, Mackey S, Abejon D. Perspective: peripheral nerve stimulation and peripheral nerve field stimulation birds of a different feather. Pain Med. 2015;16(3):411–412. doi: 10.1111/pme.12662 - DOI - PubMed

[6] Deer TR, Levy RM, Verrills P, Mackey S, Abejon D. Perspective: peripheral nerve stimulation and peripheral nerve field stimulation birds of a different feather. Pain Med. 2015;16(3):411–412. doi: 10.1111/pme.12662 - DOI - PubMed

[7] Strand N, D’Souza RS, Hagedorn JM, et al. Evidence-based clinical guidelines from the American society of pain and neuroscience for the use of implantable peripheral nerve stimulation in the treatment of chronic pain. J Pain Res. 2022;15:2483–2504. doi: 10.2147/JPR.S362204 - DOI - PMC - PubMed

[8] Strand N, D’Souza RS, Hagedorn JM, et al. Evidence-based clinical guidelines from the American society of pain and neuroscience for the use of implantable peripheral nerve stimulation in the treatment of chronic pain. J Pain Res. 2022;15:2483–2504. doi: 10.2147/JPR.S362204 - DOI - PMC - PubMed

[9] Gildenberg PL. History of electrical neuromodulation for chronic pain. Pain Med. 2006;7(s1):S7–S13.

[10] Gildenberg PL. History of electrical neuromodulation for chronic pain. Pain Med. 2006;7(s1):S7–S13.

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Consensus Guidelines from the American Society of Pain and Neuroscience for the Use of 60-Day Peripheral Nerve Stimulation Therapy. A NEURON Living Guideline Project

Affiliations

Consensus Guidelines from the American Society of Pain and Neuroscience for the Use of 60-Day Peripheral Nerve Stimulation Therapy. A NEURON Living Guideline Project

Authors

Affiliations

Abstract

Conflict of interest statement

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Abstract

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