Peripheral nerve stimulation (PNS) is an advanced treatment for chronic pain that targets specific nerves with mild electrical signals to reduce pain perception. While it can be highly effective, proper diagnosis is key to success. Unlike spinal cord stimulation, diagnosing peripheral nerve pain can be challenging. EMG and nerve conduction studies often lack sensitivity and specificity in identifying pain-generating nerves. Many patients with chronic pain—such as those with persistent knee, shoulder, back, or foot and ankle pain—may have normal or inconclusive EMG results, making these tests unreliable for guiding treatment. Instead, diagnostic nerve blocks can help pinpoint the pain source. Patients with chronic knee pain after knee replacement, shoulder pain after rotator cuff repair, or persistent SI joint pain after fusion may still have nerve-related pain. If a targeted nerve block—such as a genicular nerve block for knee pain or a suprascapular nerve block for shoulder pain—provides significant temporary relief, it strongly suggests that nerve as the pain generator. Studies show that successful diagnostic blocks are a strong predictor of positive outcomes with PNS. A PNS trial is essential before permanent implantation. Patients first undergo a temporary trial to determine if nerve stimulation provides at least 50% pain relief, which research shows strongly predicts long-term success. This is especially helpful for patients who have failed previous surgeries, such as SI fusion, knee replacement, or shoulder surgery, but still experience significant pain. For those who respond well, PNS can provide lasting relief, reduce reliance on medications, and improve function. While not for everyone, it is a valuable option when other treatments have failed. A precise diagnosis using nerve blocks and trial results leads to the best outcomes. If chronic pain persists, talk to your doctor to see if PNS is right for you.