A Prospective Multidimensional Assessment of the Impact of Payer Type, Insurance Delays, Psychological and Clinical Domains on Response to 60-Day Peripheral Nerve Stimulation: 6-Month Outcomes.

Authors

Charles A Odonkor, Salman Hirani, Siri Bohacek, Sreekrishna Pokuri, Robert M Chow, Alaa Abd-Elsayed

Published in

Pain medicine (Malden, Mass.). Oct 28, 2025. Epub Oct 28, 2025.

Abstract

To evaluate the impact of health-service (payor type and authorization delays), clinical, and psychosocial domains on outcomes at 6 months following 60-day peripheral nerve stimulation (PNS).
Prospective, single-center observational cohort study.
Academic health system-based outpatient pain clinics.
121 adult patients with chronic pain treated with temporary PNS between December 1st, 2023, through December 1st, 2024.
Baseline assessments included demographic characteristics, pain, and disability scores. The primary outcome was response to PNS characterized as responders (≥50% relief) and high responders (≥80% relief) at 60-days and 6-month follow-up. Insurance delays were categorized as no delay, short (1-14 days), or long (≥15-day) delay. Multivariate logistic regression identified predictors of response with sensitivity analyses.
At 60-days, 66.9% achieved ≥50% relief and 28.9% ≥80%. At 6 months, 78.5% and 44.6% met these thresholds, respectively. Insurance delay and high baseline disability predicted worse outcomes. Each 10-day delay reduced the odds of ≥ 50% and ≥80% relief by 89% and ≥80%, respectively. 60-day response strongly predicted 6-month benefit. Psychological and health service factors predominated at 60 days, whereas clinical (opioid use) and demographic variables (including morbid obesity) emerged at 6 months. Delayed response trajectories were observed: 62.5% of 60-day non-responders achieved ≥50% relief and 45.3% reached ≥80% relief at 6 months.
Insurance-related delays, high opioid burden, baseline disability and morbid obesity negatively influenced PNS outcomes, while psychological resilience conferred benefit. Delayed onset responders/high responders highlight the need for longitudinal follow-up and caution against premature discontinuation of PNS therapy.

PMID:
41148054
Bibliographic data and abstract were imported from PubMed on 28 Oct 2025.

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