Navigating Peripheral Nerve Stimulation: Key Takeaways from ASPN Guidelines

The ASPN guidelines clarify indications and payer-advocacy strategies for peripheral nerve stimulation (PNS), specifying which clinical scenarios and documentation practices can reduce longstanding access barriers for pain-management teams.This raises the importance of careful device selection, trial approaches, and thorough coverage documentation to improve access.

Previously, uncertainty produced variable patient selection and inconsistent trial strategies that complicated outcomes and reimbursement. The guideline delineates clearer indications across chronic neuropathic pain and postsurgical neuropathy and elevates brief neuromodulation trials within care pathways.

In practice, that clarity narrows the eligible cohort, reduces low-yield implants, and reshapes clinic workflow by formalizing trial-to-implant steps—enabling earlier, protocolized screening and standardized documentation to support appropriateness determinations and payer discussions.

The guideline recommends PNS most strongly for defined chronic neuropathic syndromes, postsurgical neuropathy, and selected traumatic nerve injuries based on the available evidence summarized in the guideline. It also champions short-term systems as a purposeful step to identify responders rapidly and limit permanent implantation to those with clinically meaningful benefit. Time-limited trials yield quick efficacy data, reduce exposure to long-term implant risks, and provide a defensible economic rationale in payer negotiations—tightening selection criteria and aligning outcomes with coverage expectations.

Device attributes—implant permanence, lead design, and infection profile—materially influence complication risk, reoperation rates, and payer receptivity. Payers commonly differentiate durable implants from temporary systems when assessing medical necessity, emphasizing documented trial response and safety metrics.

The guideline underscores advanced practice provider (APP) involvement in assessment, structured documentation, and appeals to compile objective trial data and to narrate medical necessity clearly. Aligning device selection with robust APP-led documentation and a clear trial record improves the likelihood of favorable coverage decisions.

Taken together, the guideline provides high-confidence recommendations that synchronize clinical indications, efficient short-term trials, and APP-driven documentation to optimize patient selection and strengthen payer negotiations.

Looking ahead, guideline-aligned pathways offer a practical route to enhance access and to support coverage decisions.

Key Takeaways:

• Guideline clarifies indications and supports PNS as an opioid-sparing option for defined chronic neuropathic cohorts.
• Short-term systems are endorsed to identify responders quickly and to reduce exposure from permanent implants—an argument that resonates in payer discussions.
• Device choice, paired with APP-led documentation and structured appeals, are practical levers to improve coverage outcomes.