Peripheral nerve stimulation, available right here in Lawrenceville, NJ
PNS is a small implanted device that quiets long-lasting nerve pain when medications, physical therapy, and injections have not given you enough relief. We also offer ReActiv8, a related implant for ongoing lower back pain.
Who it is for:
- Long-lasting knee, shoulder, head, or nerve pain that comes from one specific nerve
- Pain that did not go away after back surgery, or pain that started after surgery
- Long-term lower back pain caused by weak deep back muscles (treated with ReActiv8)
or call 609-588-8600 · Lawrenceville, NJ office
By Matthias Wiederholz, MD with Performance Pain and Sports Medicine
Updated May 2026
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What Is Peripheral Nerve Stimulation?
When chronic pain does not respond to medications, physical therapy, or injections, a peripheral nerve stimulator may offer a targeted solution. Peripheral nerve stimulation (PNS) is a minimally invasive form of neuromodulation that delivers mild electrical impulses directly to specific nerves outside the spinal cord. These impulses interrupt pain signals before they reach the brain, reducing the sensation of pain at its source (Ong Sio et al., Int J Mol Sci, 2023).
The technology is based on the gate control theory of pain. Stimulating large nerve fibers can block smaller pain-carrying fibers from transmitting signals to the brain. PNS has gained recognition as a safe, evidence-based treatment option, with five FDA-cleared systems now available and clinical guideline support from the American Society of Interventional Pain Physicians (Manchikanti et al., Pain Physician, 2024).
Unlike TENS units, which deliver stimulation through pads placed on the skin, PNS uses a small implanted lead positioned directly next to the target nerve. This provides stronger, more precise pain relief for chronic conditions (Knotkova et al., Lancet, 2021).
Conditions Treated with Peripheral Nerve Stimulation in Lawrenceville, NJ
PNS can target pain in nearly any area of the body where a specific nerve or nerve group is causing symptoms. At the Lawrenceville, NJ office of Performance Pain and Sports Medicine, Dr. Matthias Wiederholz evaluates patients for PNS across a range of chronic pain conditions.
Clinical guidelines support PNS for multiple indications, with Level I evidence for chronic migraine, hemiplegic shoulder pain, failed back surgery syndrome, and lower extremity neuropathic pain (Strand et al., J Pain Res, 2022). Conditions commonly treated with PNS include:
- Chronic knee pain, including pain after knee replacement or arthroscopy (Kelly et al., Cureus, 2023)
- Chronic shoulder pain, with published evidence supporting axillary nerve stimulation for refractory cases (Mansfield & Desai, Neuromodulation, 2020)
- Chronic mechanical low back pain linked to multifidus muscle dysfunction, treated with the ReActiv8 restorative neurostimulation system covered in detail below
- Other low back pain patterns, with a systematic review finding consistent improvements in pain intensity across multiple PNS approaches (D’Souza et al., Curr Pain Headache Rep, 2023)
- Occipital neuralgia and chronic headaches
- Neuropathic pain, including diabetic neuropathy, CRPS, and post-amputation phantom limb pain
- Failed back surgery syndrome
Who Is a Good Candidate for PNS?
PNS may be appropriate for patients whose chronic pain has not improved after trying at least two conservative treatments, such as medications, physical therapy, epidural steroid injections, or radiofrequency ablation. The ASIPP guidelines recommend PNS for patients with pain that can be traced to a specific peripheral nerve or nerve group (Manchikanti et al., Pain Physician, 2024).
PNS works best when a single nerve or cluster of nerves can be identified as the source of pain. A diagnostic nerve block is typically performed first to confirm that the targeted nerve is responsible for symptoms. Patients who experience significant relief from the block are strong candidates for a PNS trial (Chow et al., Curr Pain Headache Rep, 2023).
PNS may not be recommended for patients with active infection at the implant site, certain blood clotting disorders, or an inability to manage the external device components.
The PNS Procedure: Trial and Implant
The PNS process at Performance Pain and Sports Medicine follows a careful, stepped approach to confirm the treatment works before committing to a permanent system.
Step 1: The trial period. A thin, flexible lead is placed near the target nerve using ultrasound or fluoroscopic guidance. The procedure is performed in the office under local anesthesia. Depending on the system used, the trial lasts from 5 to 60 days. During this time, patients wear a small external controller that powers the stimulator. The goal is to confirm at least a 50% reduction in pain before moving forward.
Step 2: Permanent implant. If the trial is successful, the team implants a small permanent pulse generator near the treatment site. This outpatient procedure typically takes less than an hour. Temporary systems, such as the SPRINT PNS, are designed for a 60-day treatment period and are then removed. A prospective study using this approach found that 67% of patients maintained meaningful pain relief one year after the lead was removed (Gilmore et al., Pain Practice, 2020).
An independent health technology assessment confirmed that permanent PNS likely decreases pain scores, likely improves functional outcomes, and likely improves quality of life (Ontario Health, 2024).
PNS Devices and Systems
Several types of nerve stimulators are FDA-cleared for peripheral nerve stimulation, each designed for different clinical needs. Dr. matthias wiederholz helps patients select the system best suited to their condition and lifestyle.
Current PNS systems include:
- SPRINT PNS System by SPR Therapeutics, a temporary percutaneous system designed for 60-day treatment cycles with the lead removed after treatment
- Nalu Neurostimulation System, a micro-implantable pulse generator for long-term use with an external wearable therapy disc
- StimRouter by Bioness, a permanently implanted lead powered by an external transmitter
- Freedom Stimulator by Curonix (formerly StimWave), a wireless system with no implanted battery
- ReActiv8 by Mainstay Medical, a restorative neurostimulation system designed specifically for chronic mechanical low back pain — covered in detail in the next section
The choice of device depends on the location of pain, whether temporary or permanent stimulation is needed, and individual patient factors. The practice discusses all available options during the consultation.
ReActiv8 for Chronic Mechanical Low Back Pain
ReActiv8 is a specialized neurostimulation system designed for one specific cause of chronic low back pain: dysfunction of the multifidus muscle. Unlike traditional peripheral nerve stimulation, which interrupts pain signals before they reach the brain, ReActiv8 takes a different approach. It restores normal function to the deep stabilizing muscle of the lower spine. For this reason, the FDA classifies ReActiv8 as restorative neurostimulation rather than classical PNS, but it is performed by the same neuromodulation specialists and follows a similar implant pathway.
How ReActiv8 Works
The multifidus muscle controls fine motor stability in the lumbar spine. When this muscle is inhibited or weakened, often after injury or chronic pain, it cannot stabilize the spine properly, and pain becomes self-sustaining. ReActiv8 delivers brief electrical stimulation to the medial branches of the L2 dorsal rami, the nerves that control the multifidus. This produces strong contractions that retrain the muscle over time (Thomson et al., Reg Anesth Pain Med, 2025).
The therapy is not continuous. Patients self-administer two 30-minute stimulation sessions per day using a handheld remote, allowing the muscle to gradually rebuild control over weeks and months (Mitchell et al., Neuromodulation, 2021).
Who Is a Candidate for ReActiv8?
ReActiv8 is FDA-approved for adults with chronic mechanical low back pain who:
- Have had pain for at least six months despite conservative treatments such as medications and physical therapy
- Have evidence of multifidus muscle dysfunction, often confirmed by a positive prone instability test
- Are not currently candidates for spine surgery
- Have not had previous lumbar fusion
This pattern — back pain greater than leg pain, no surgical fix, failed conservative care — describes one of the most common reasons patients walk into a pain practice. ReActiv8 may offer a path forward when other neuromodulation approaches are not appropriate.
Clinical Evidence
The ReActiv8-B pivotal trial enrolled 204 patients with refractory mechanical chronic low back pain and tracked them for five years. The results were durable:
- 71.8% of patients had at least a 50% reduction in low back pain at five years (Gilligan et al., Neuromodulation, 2024)
- Mean pain scores fell from 7.3 to 2.4 on a 10-cm visual analog scale at five years
- Disability scores (Oswestry Disability Index) dropped from 39.1 to 16.5
- 46% of patients on opioids at baseline discontinued them, and another 23% reduced their dose
- 83% of patients had clinically substantial improvements in pain, disability, or both at three years (Gilligan et al., Neuromodulation, 2022)
A separate randomized trial called RESTORE compared ReActiv8 directly to optimal medical management. At one year, the ReActiv8 group had significantly greater improvements in pain, disability, and quality of life than the medical management group (Schwab et al., Pain Ther, 2025).
ReActiv8 is reversible. The implant can be removed if needed, and no lead migrations were reported in the five-year ReActiv8-B follow-up.
Benefits and Expected Results
A growing body of research supports the effectiveness of PNS for chronic pain. A 2025 systematic review and meta-analysis of randomized controlled trials found that patients achieved significant pain relief, with benefits sustained for at least 12 months across both permanent and temporary PNS systems (Manchikanti et al., Pain Physician, 2025).
Condition-specific outcomes from published studies include:
- Knee pain: 75% of patients reported 50% or greater pain reduction at six months (Kelly et al., 2023)
- Shoulder pain: 88% responder rate among patients with refractory chronic shoulder pain in a case series (Mansfield & Desai, 2020)
- Postoperative pain: A sham-controlled trial found PNS reduced opioid use by 80% in the first week following orthopedic surgery (Ilfeld et al., Anesthesiology, 2021)
PNS is reversible and adjustable. If a patient’s needs change, the stimulator settings can be reprogrammed. The device can also be removed without permanent changes to the nerve.
PNS vs. Spinal Cord Stimulation: Key Differences
Both PNS and spinal cord stimulation (SCS) are forms of neuromodulation, but they work differently and serve different types of pain.
| PNS | SCS | |
|---|---|---|
| Target | Specific peripheral nerves | Spinal cord |
| Best for | Focal, nerve-specific pain (knee, shoulder, occipital) | Widespread pain (legs, back, neuropathy) |
| Invasiveness | Less invasive, often percutaneous | Requires epidural lead placement |
| Temporary option | Yes (60-day percutaneous systems) | No |
Research has shown that both PNS and SCS produce comparable reductions in pain intensity (Meyer-Friessem et al., Clin J Pain, 2019). The two approaches are not mutually exclusive. Some patients benefit from both, and the team may also consider DRG stimulation when pain is concentrated in a specific nerve root territory.
Recovery After Peripheral Nerve Stimulation
Recovery from PNS is typically straightforward. After a trial lead placement, most patients can resume normal daily activities within 24 to 48 hours. Strenuous exercise and heavy lifting should be avoided during the trial period.
Following a permanent implant, patients generally return to regular activities within one to two weeks. The team schedules follow-up appointments to program and fine-tune stimulator settings for the best pain relief. For procedures performed during winter months, patients are advised to plan for indoor mobility during icy weather and to schedule any post-op follow-up around weather forecasts.
The safety profile of PNS is well-documented. An independent health technology assessment found that most adverse events were mild and localized, such as temporary soreness at the lead site (Ontario Health, 2024).
Why Choose Performance Pain and Sports Medicine for PNS in Lawrenceville, NJ
Performance Pain and Sports Medicine offers central New Jersey patients a complete neuromodulation program — peripheral nerve stimulation, ReActiv8 restorative neurostimulation, spinal cord stimulation, and DRG stimulation — without the drive into Manhattan or Philadelphia for advanced pain care.
Dr. Matthias Wiederholz, MD, founded Performance Pain and Sports Medicine and leads the Lawrenceville practice. He is quadruple board-certified in Physical Medicine and Rehabilitation, Pain Medicine, Sports Medicine, and Anti-Aging, Regenerative and Functional Medicine. His practice focuses on minimally invasive spine treatments and advanced neuromodulation for patients who want non-surgical options.
The Lawrenceville office sits at 4056 Quakerbridge Road, Suite 112, in the building complex shared with Silver Pharmacy and Jag Physical Therapy, approximately one mile from Quakerbridge Mall. Patients arrive from across Mercer County and the broader Princeton area, including Princeton, Pennington, Hopewell, Hamilton, Trenton, Ewing, Plainsboro, West Windsor, and Robbinsville. The office is approximately eight minutes from Hamilton Train Station and reachable from the Northeast Corridor for patients commuting from New York City and Philadelphia.
Lawrenceville sits in one of the densest pharmaceutical and biomedical research corridors in the United States, anchored by Bristol Myers Squibb’s Lawrence Township facility and the broader Route 1 research belt. The practice mirrors that ecosystem’s standard for evidence-based, peer-reviewed care.
Frequently Asked Questions About Peripheral Nerve Stimulation
How much does peripheral nerve stimulation cost?
The cost of PNS varies depending on the device system used and the complexity of the procedure. Many insurance plans cover PNS when it is determined to be medically necessary. Performance Pain and Sports Medicine assists patients with insurance verification and prior authorization.
Does insurance cover peripheral nerve stimulation?
Many commercial insurance plans and Medicare may cover PNS for approved indications. Coverage typically requires prior authorization and documentation that conservative treatments have been tried. The ASIPP guidelines support expanding coverage criteria for PNS based on the growing evidence of its effectiveness (Manchikanti et al., Pain Physician, 2024).
What is the success rate of peripheral nerve stimulation?
Clinical studies show that a majority of patients experience meaningful pain relief. A systematic review of randomized controlled trials found significant pain reduction sustained for at least 12 months (Manchikanti et al., 2025). For chronic knee pain specifically, 75% of patients reported 50% or greater improvement at six months (Kelly et al., 2023). For ReActiv8 in chronic mechanical low back pain, 71.8% of patients had at least a 50% reduction in pain at five years (Gilligan et al., 2024).
Is peripheral nerve stimulation the same as TENS?
No. TENS (transcutaneous electrical nerve stimulation) uses adhesive pads on the skin to deliver surface-level stimulation. PNS places a small lead directly next to the target nerve, providing stronger and more focused pain relief. PNS is a medical procedure performed by a physician, while TENS is an over-the-counter device.
How long does a peripheral nerve stimulator last?
Permanent PNS systems are designed for long-term use, with rechargeable battery options available depending on the device. Temporary percutaneous systems, such as the SPRINT PNS, are used for a 60-day treatment period and then removed. Early evidence shows sustained pain relief for at least 12 months after the temporary lead is removed (Gilmore et al., 2020).
Can I get an MRI with a peripheral nerve stimulator?
MRI compatibility depends on the specific device. Some newer PNS systems are MRI-conditional, meaning MRI scans may be performed under certain conditions. Patients should discuss MRI safety with their provider before scheduling any imaging.
What happens during the PNS trial period?
A temporary lead is placed near the target nerve in an office-based procedure. Patients wear a small external device during the trial, which typically lasts 5 to 60 days depending on the system. If pain decreases by 50% or more, the patient may move forward with a permanent implant or complete the full temporary treatment cycle.
How long is recovery after PNS?
Most patients resume daily activities within 24 to 48 hours after a trial lead placement. After a permanent implant, recovery typically takes one to two weeks. Follow-up visits are scheduled to adjust stimulator settings.
Schedule Your Peripheral Nerve Stimulation Consultation in Lawrenceville, NJ
To find out if peripheral nerve stimulation or ReActiv8 may be right for your chronic pain, request an appointment with the pain management team at the Lawrenceville, NJ office.
Performance Pain and Sports Medicine
4056 Quakerbridge Road, Suite 112
Lawrenceville, NJ 08648
Phone: 609-588-8600
Open by appointment, Monday through Friday.
Located on Quakerbridge Road approximately one mile from Quakerbridge Mall, just past the intersection of Youngs Road, in the building complex shared with Silver Pharmacy and Jag Physical Therapy. Approximately eight minutes from Hamilton Train Station for Northeast Corridor patients.
MEDICAL DISCLAIMER
This article is for educational purposes only and does not replace professional medical advice, diagnosis, or treatment. The information presented reflects an interventional pain management perspective and is intended to support, not substitute, your relationship with a qualified healthcare provider. Individual results vary based on diagnosis, pain duration, overall health, and response to treatment. Some procedures may not be covered by insurance. Treatment outcomes depend on proper patient selection and accurate diagnosis. Always consult a board-certified physician before pursuing any pain management treatment.
Medically reviewed by: Dr. Matthias Wiederholz, MD, quadruple board-certified in Physical Medicine and Rehabilitation, Pain Medicine, Sports Medicine, and Anti-Aging, Regenerative and Functional Medicine
Review date: May 2026
