Mechanism of Peripheral Nerve Stimulation in Chronic Pain

Abstract

Introduction With the advancement of technology, peripheral nerve stimulation (PNS) has been increasingly used to treat various chronic pain conditions. Its origin is based on the gate control theory postulated by Wall and Melzack in 1965. However, the exact mechanism behind PNS’ analgesic effect is largely unknown. In this article, we performed a comprehensive literature review to overview the PNS mechanism of action. Design A comprehensive literature review on the mechanism of PNS in chronic pain. Methods Comprehensive review of the available literature on the mechanism of PNS in chronic pain. Data were derived from database searches of PubMed, Scopus, and the Cochrane Library and manual searches of bibliographies and known primary or review articles. Results Animal, human, and imaging studies have demonstrated the peripheral and central analgesic mechanisms of PNS by modulating the inflammatory pathways, the autonomic nervous system, the endogenous pain inhibition pathways, and involvement of the cortical and subcortical areas. Conclusions Peripheral nerve stimulation exhibits its neuromodulatory effect both peripherally and centrally. Further understanding of the mechanism of PNS can help guide stimulation approaches and parameters to optimize the use of PNS.

Comparing neuromodulation modalities involving the suprascapular nerve in chronic refractory shoulder pain: retrospective case series and literature review

“…In this case series, the suprascapular nerve was the target of neuromodulation over the axillary nerve as the suprascapular nerve comprises 70% of sensory supply to the shoulder joint, the capsule, and the overlying skin as well as providing motor innervation to two of the rotator cuff muscles [13]. The analgesic action of PNS therapy is multi-modal and acts both via peripheral and central analgesic mechanisms including modulating inflammatory pathways, the autonomic nervous system, the endogenous pain inhibition pathways, with the involvement of cortical and subcortical areas [14]. p-RF therapy, which involves delivering rapid bursts of electromagnetic fields to the target, is known to enhance the descending pain inhibitory pathways [15].…”

Peripherally Induced Reconditioning of the Central Nervous System: A Proposed Mechanistic Theory for Sustained Relief of Chronic Pain with Percutaneous Peripheral Nerve Stimulation

“…92,125 For example, additional proposed mechanisms of action for conventional stimulation include both peripheral (eg, altering nerve fiber excitability or conduction), and central factors (eg, inducing or depleting excitatory and/or inhibitory neurotransmitters, modulating expression of neuronal signaling proteins, altering activity in central pain matrix regions or descending inhibitory pathways). 9,[132][133][134] These additional mechanisms highlight the overall complexity of the chronic pain state, though spinal segmental mechanisms remain the predominate mechanistic theory for pain relief with conventional neurostimulation.…”

Understanding the Role of Patient Preference in the Treatment Algorithm for Chronic Low Back Pain: Results from a Survey-Based Study

“…Of note, the mechanisms of action for temporary PNS may be related to the direct activation of sensory afferents and reduction of the spinothalamic tract's activity (the gate control theory); it is also reasonable to discuss the effect of medial branch stimulation and the resultant tension produced in the multifidis, resulting in the indirect activation of afferent and proprioceptive fibers that may affect CNS changes, resulting in pain relief [37]. Temporary and permanent PNS systems may achieve the direct and indirect activation of sensory afferents with waveform techniques such as choosing higher and lower (2-20 Hz) frequencies, respectively [38].…”