BlueCross BlueShield of Tennessee Medical Policy Manual

Peripheral Subcutaneous Field Stimulation for the Treatment of Pain


Peripheral subcutaneous field stimulation (PSFS) is a form of neuromodulation intended to treat chronic neuropathic pain. Applications of PSFS being evaluated are craniofacial stimulation for headache and migraine, craniofacial pain, or occipital neuralgia. PSFS is also being investigated for low back, neck, and shoulder pain, inguinal and pelvic pain, thoracic pain, abdominal pain, fibromyalgia and postherpetic neuralgia. With this method, leads are placed subcutaneously within the area of maximal pain with the objective of stimulating the region of affected nerves, cutaneous afferents or the dermatomal distribution of the nerves, which then converge back on the spinal cord. The mechanism of action in PSFS is unknown. There are no FDA devices approved for this use. PSFS is an off-label use of spinal cord stimulation devices that have been FDA approved.




Prospective controlled trials comparing peripheral subcutaneous field stimulation with placebo or alternative treatment modalities are needed to determine the efficacy of this treatment for chronic pain. Currently the evidence is insufficient to determine the effects of the technology on health outcomes.


BlueCross BlueShield Association. Medical Policy Reference Manual. (4:2018). Peripheral subcutaneous field stimulation (7.01.139). Retrieved May 21, 2018 from BlueWeb. (7 articles and/ or guidelines reviewed)

Eldabe, S., Taylor, R., Goossens, S., Bouche, B., G├╝ltuna, I., Green, C., et al. (2018). A randomized controlled trial of subcutaneous nerve stimulation for back pain due to failed back surgery syndrome: the SubQStim study. Neuromodulation, doi: 10.111/ner.12784. [Epub ahead of print]

Kloimstein, H., Likar, R., Kern, M., Neuhold, J., Cada, M., Loning, N., et al. (2014). Peripheral nerve field stimulation (PNFS) in chronic low back pain: a prospective multicenter study. Neuromodulation, 17 (2), 180-187. Abstract retrieved May 21, 2018 from PubMed database.

National Institute for Health and Care Excellence. (2013, March). Interventional procedural guidance: Peripheral nerve-field stimulation for chronic low back pain. Retrieved April 30, 2013

Verrills, P., Rose, R., Mitchell, B., Vivian, D., & Barnard, A. (2014). Peripheral nerve field stimulation for chronic headache: 60 cases and long-term follow-up. Neuromodulation, 17 (1), 54-59. Abstract retrieved May 21, 2018 from PubMed database.




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