177: The use of 5Hz bursts may help improve refractory chronic lower back pain.

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic neuropathic pain, Non-pharmacological treatments

Background and Aims: Objective :
Chronic low back pain is a common cause of disability and one that is difficult to treat effectively but PNFS can be effective to treat patients. But sometimes the efficiency was decreased during time. To increase the benefice of this therapy, burst 5Hz was tried to decrease pain.

Methods: Materiels ans method : a retrospective analysis of 10 patients with chronic lumbar pain and implantation of a PNFS-system was performed in our center. Leads were placed in the subcutaneous tissues of the lower back directly in the region of greatest pain. Pain intensity (NRS), health-related quality of life (EQ-5D-5L), Beck scale for mood, and treatment satisfaction (PGI) were assessed pre/postoperatively, after 6 months.

Results: Results :10 patients (7 women and 3 men) were implanted with PNFS, 3 with PNFS alone and 7 with spinal cord stimulation plus PNFS. Mean age was 51 years old. Preop VAS was 7.5 and post op VAS was 4.1. Charging with PNFS need to have at least once a day. With burst 5hz patients decrease low back pain and frequency of charging. Setting for PNFS range to 1.9mA to 17.9mA with pulse width range from 120 to 220µsec. Quality of life was improved and medication was decrease at lease 30% with cessation of morphinic used.

Conclusions: Conclusion : This preliminary study shows that 5Hz bursts can be used to improve the management of low back pain with PNFS. There is little evidence in the literature supporting the use of 5Hz bursts or less.
A small cohort study showed that burst mode can offer analgesia comparable to tonic mode and a similar reduction in analgesic use, with the potential benefit of being paresthesia-free.
This suggests that, theoretically, burst mode could be relevant in subcutaneously implanted stimulation systems.

References: 1. Kloimstein H, Likar R, Kern M, Neuhold J, Cada M, Loinig N, et al.
Peripheral Nerve Field Stimulation (PNFS) in Chronic Low Back Pain: A Prospective Multicenter Study.
Neuromodulation. 2014 Feb;17(2):180–187.
– Prospective, multicenter observational trial showing significant pain and functional improvements following PNFS implantation in patients with cLBP.
2. Verrills P, Vivian D, Mitchell B, Barnard A.
Peripheral Nerve Field Stimulation for Chronic Pain: 100 Cases and Review of the Literature.
Pain Medicine. Sep 2011;12(9):1395–1405.
– A large case series covering PNFS outcomes across pain conditions including lumbosacral pain.
3. Paicius RM, Bernstein CA, Lempert-Cohen C.
Peripheral Nerve Field Stimulation for the Treatment of Chronic Low Back Pain: Preliminary Long-Term Follow-Up Case Series.
Neuromodulation. 2007 Jul;10(3):279–290.
– Early case evidence of PNFS safety/effectiveness in cLBP.
4. Schwarm FP, Stein M, Uhl E, Maxeiner H, Kolodziej MA.
Retrospective Analysis of 25 Cases With Peripheral Nerve Field Stimulation for Chronic Low Back Pain and Predictive Value of TENS.
Neuromodulation. 2019 Jul;22(5):607–614.
– Shows significant pain, quality of life improvements after PNFS; TENS did not predict response.
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🔎 Reviews & Broader Evidence Syntheses
5. Wong CH, Chan TCW, Wong SSC, Russo M, Cheung CW.
Efficacy of Peripheral Nerve Field Stimulation for Chronic Low Back Pain and Persistent Spinal Pain Syndrome: A Narrative Review.
Neuromodulation. 2023 Apr;26(3):538–551.
– Systematic narrative review including RCTs and observational studies on PNFS, suggesting effectiveness but calling for larger RCTs.
6. D’Souza RS, Jin MY, Abd-Elsayed A.
Peripheral Nerve Stimulation for Low Back Pain: A Systematic Review.
Curr Pain Headache Rep. 2023 May;27(5):117–128.
– Broader review of PNS including PNFS outcomes for cLBP.
7. N Strand et al.
Implantable Peripheral Nerve Stimulation for Chronic Pain (Evidence-Based Clinical Guidelines).
– Guidelines summarizing evidence for PNS/PNFS in various chronic pain conditions including cLBP.
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🧠 Studies Linking PNFS with Other Neuromodulation Paradigms (“Burst”, HF, SCS + PNFS)
8. Rigoard P et al.
The Added Value of Subcutaneous PNFS Combined with Spinal Cord Stimulation (SCS) as Salvage Therapy for Persistent Back Pain.
J Clin Med. 2021;10(21):5094.
– RCT investigating PNFS as salvage therapy combined with SCS for refractory back pain.
9. Moore DM et al.
Neurostimulation Therapies for Chronic Back Pain: Burst, HF SCS, and PNFS Insights.
– Evidence suggests newer stimulation modalities like burst SCS may enhance pain outcomes and may be used together with PNFS approaches.
10. Slavin KV, et al.
Spinal Stimulation for Pain (Including Burst Waveforms).
– Burst stimulation, a waveform initially developed for SCS, can modulate pain pathways differently and is of interest in evolving neuromodulation protocols that may include PNFS.

Presenting Author: sylvie raoul
Submitting Author: Sylvie Raoul

Senior Author: sylvie raoul

IASP 2026 Global Year theme of Neuropathic Pain: Yes

• stephanie ravaillaut: MD - chu nantes
• francois leger: MD - chu nantes
• julien nizard: MD, phD - chu nantes