Charles A. Odonkor, Salman Hirani, Siri Bohacek, Sreekrishna Pokuri, Robert Chow, Alaa Abd‐Elsayed
OBJECTIVES: 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). DESIGN: Prospective, single-center observational cohort study. SETTING: Academic health system-based outpatient pain clinics. SUBJECTS: In total, 121 adult patients with chronic pain treated with temporary PNS between December 1, 2023, through December 1, 2024. METHODS: 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. RESULTS: 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. The 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. CONCLUSIONS: 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.