Medical Necessity of Peripheral Nerve Stimulation for Meralgia Paresthetica

Patient Selection Criteria

The American Society of Anesthesiologists recommends peripheral nerve stimulation for patients with chronic intractable pain that has been refractory to medication management, with no evidence of drug addiction, and no psychological contraindication, as seen in patients with meralgia paresthetica 1
Patients with intractable meralgia paresthetica who have failed conservative treatments are considered appropriate candidates for neuromodulation techniques, including peripheral nerve stimulation, according to the American Society of Anesthesiologists 1, 2, 3

First-line treatment for meralgia paresthetica includes conservative management with medications such as gabapentin and pregabalin, as recommended by the American Diabetes Association 4
Physical therapy is also a recommended first-line treatment for meralgia paresthetica, according to the American Society of Anesthesiologists 1

The American Society of Anesthesiologists notes that procedural complications, such as infection and device migration, are potential risks associated with peripheral nerve stimulation 1

The American Society of Anesthesiologists recommends subcutaneous peripheral nerve stimulation for patients with painful peripheral nerve injuries who have not responded to other therapies 5, 6
Peripheral nerve stimulation may be used in the multimodal treatment of patients with intractable neuropathic pain 5

A stimulation trial should be performed before considering permanent implantation 5, 6
Shared decision-making should include discussion of potential complications 5, 6
Appropriate image guidance should be used for accurate placement 5

The Sprint PNS System is classified as having insufficient evidence for treating chronic pain conditions, according to the Mayo Clinic Proceedings 7

The American Academy of Neurology or other guideline societies may recommend alternative treatments, but the Sprint PNS System is not considered medically necessary for treating meralgia paresthetica due to insufficient evidence 7