Peripheral nerve field stimulation for chronic low back pain: a systematic review

Abstract

Chronic low back pain (CLBP) presents a major challenge in pain management, often persisting despite standard therapies. Peripheral nerve field stimulation (PNFS), also known as subcutaneous stimulation, offers a minimally invasive neuromodulation approach that may improve outcomes for these patients. This systematic review evaluates the evidence on PNFS, alone or combined with spinal cord stimulation (SCS), for CLBP, focusing on pain relief, functional outcomes, and safety. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, databases including Cochrane, Embase, MEDLINE (PubMed), and the Université Laval Library were searched for studies from January 2014 to April 2025. Nineteen studies (randomized controlled trials, cohort studies, and case series) were included. Outcomes assessed included pain intensity, disability (Oswestry Disability Index), quality of life (36-Item Short Form Health Survey, EuroQol 5-Dimension), and adverse events. Across study-level estimates, PNFS monotherapy most commonly produced approximately 40% to 60% reductions in pain intensity, although reported effects varied across studies and were not pooled because of heterogeneity. Functional gains included reduced disability and improved mobility. Quality of life measures and medication use often improved. Peripheral nerve field stimulation combined with SCS yielded mixed results, providing benefits particularly for patients unresponsive to SCS alone. Reported complication rates were generally modest, with infections and lead migrations being the most common. Peripheral nerve field stimulation appears to be a promising and generally well-tolerated option for selected patients with CLBP, although evidence certainty remains limited, and larger controlled studies are needed.