Thanks to developing technology that uses a mild electrical current to block the pain signal, expert teams like those at the NorthShore Orthopaedic & Spine Institute (NOSI) are offering patients a path to opioid-free surgery and relief for chronic pain.

It's called percutaneous peripheral nerve stimulation (PNS).

How does it work?

This innovative treatment involves implanting a tiny wire or lead, about the size of a hair, next to a nerve. Following the simple, outpatient procedure, an external stimulator is used to send minute electrical signals to targeted nerve fibers in the area where the pain is felt, blocking the transmission of pain signals. 

A recent study published in the journal, Anesthesiology, reflected dramatic results for orthopaedic surgery patients with PNS including an 80 percent decrease in the use of opioids following surgery, and significantly lower pain scores compared to patients without PNS. 

“A breakthrough like this that leads to a more than 50% reduction in pain, and 80% reduction in opioid use is so meaningful for patients and even has benefits for friends and family members caring for them after surgery,” said NorthShore Pain Medicine Section Chief David Dickerson, MD, who also serves as the American Society of Anesthesiologists Committee on Pain Medicine Chairman. 

Dr. Dickerson is optimistic about significant developments like PNS that offer an alternative to opioid use, as it is clear that surgery and postoperative prescriptions can be a gateway to potential opioid abuse.

Part of NorthShore’s team-based NOSI, Dr. Dickerson partners with surgeons like Ravi Bashyal, MD, Director of Outpatient Hip and Knee Replacement, who are thrilled to offer this option to patients. 

The cutting-edge pain-management therapy, combined with advances in minimally-invasive techniques, robotics, and patient-specific instrumentation, allows Dr. Bashyal to offer knee replacement as an opioid-free, outpatient procedure to a select group of patients.

What's the process? 

For many patients the PNS can be implanted a few weeks before surgery and removed a few weeks after the procedure, allowing them to avoid opioids altogether or for those already on opioids it can diminish the need for more medication to manage post-surgical pain. 

And, for a small group of patients who continue to have significant pain weeks after surgery, PNS can offer significant relief where increased opioids used to be the only option, said Dr. Bashyal.

What can we expect in the future?

As leaders in their fields, both Dr. Dickerson and Dr. Bashyal are working to help advance the PNS technology and educate other orthopaedic surgeons on its use and benefits for patients.

They stressed the importance of the collaborative model of care at NOSI, where surgeons, anesthesiologists, pain management specialists, and an entire team of caregivers work together and communicate seamlessly—a departure from traditional models of care.

“This is still very cutting-edge in the hip and knee replacement world and is especially important in light of the opioid epidemic,” said Dr. Bashyal. “Patient satisfaction scores are up, medication use is down and overall outcomes are improved. This is a win-win.”