Peripheral Nerve Stimulation in Pain Management: A Systematic Review

Abstract

BACKGROUND: Peripheral nerve stimulation (PNS) has been increasingly used to manage acute and chronic pain. However, the level of clinical evidence to support its use is not clear. OBJECTIVES: To assess the clinical evidence of PNS in the treatment of acute or chronic pain. STUDY DESIGN: A systematic review of the efficacy and safety of PNS in managing acute or chronic pain. METHODS: Data sources were PubMed, Cochrane Library, Scopus, CINAHL Plus, Google Scholar, and reference lists. The literature search was performed up to December 2019. Study selection included randomized trials, observational studies, and case reports of PNS in acute or chronic pain. Data extraction and methodological quality assessment were performed utilizing Cochrane review methodologic quality assessment and Interventional Pain Management Techniques–Quality Appraisal of Reliability and Risk of Bias Assessment (IPM-QRB) and Interventional Pain Management Techniques–Quality Appraisal of Reliability and Risk of Bias Assessment for Nonrandomized Studies (IPM-QRBNR). The evidence was summarized utilizing principles of best evidence synthesis on a scale of 1 to 5. Data syntheses: 227 studies met inclusion criteria and were included in qualitative synthesis. RESULTS: Evidence synthesis based on randomized controlled trials (RCTs) and observational studies showed Level I and II evidence of PNS in chronic migraine headache; Level II evidence in cluster headache, postamputation pain, chronic pelvic pain, chronic low back and lower extremity pain; and Level IV evidence in peripheral neuropathic pain, and postsurgical pain. Peripheral field stimulation has Level II evidence in chronic low back pain, and Level IV evidence in cranial pain. LIMITATIONS: Lack of high-quality RCTs. Meta-analysis was not possible due to wide variations in experimental design, research protocol, and heterogeneity of study population. CONCLUSIONS: The findings of this systematic review suggest that PNS may be effective in managing chronic headaches, postamputation pain, chronic pelvic pain, and chronic low back and lower extremity pain, with variable levels of evidence in favor of this technique. KEY WORDS: Acute pain, chronic pain, neuromodulation, peripheral nerve stimulation

Can Wireless Transcutaneous Nerve Stimulation Applied to the Genital Nerve Manage Urinary Incontinence Following Spinal Cord Injury and Multiple Sclerosis?

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Neuromodulation for Peripheral Nerve Regeneration: Systematic Review of Mechanisms and In Vivo Highlights

“…Common questionnaires to assess these symptoms include the Visual Analogue Scale (VAS) and the Numeric Rating Scale (NRS) for pain, and the Short-Form Health Survey (SF-36) for physical function. Currently, neuromodulation is reserved for when symptoms are refractory to other treatment modalities [ 25 ]. Prior to intervention, patients first undergo a diagnostic nerve block to confirm that the correct nerve is targeted and that the patient experiences at least a 50% reduction in pain [ 14 ].…”

Combined use of peripheral nerve stimulation and dorsal root ganglion stimulation for refractory complex regional pain syndrome type I to avoid amputation: A case report

“…Peripheral nerve and dorsal root ganglion stimulation (DRG-s) are effective treatment modalities for focal neuropathic pain including complex regional pain syndrome (CRPS) that is limited to one or two dermatomes. 2,4,15 While a reduction in pain of fifty percent or greater is often deemed a satisfactory response in the treatment of chronic pain, we describe a case were the patient sought amputation of her limb in the hopes a prosthetic extremity would provide improved function. Despite the risk of post amputation pain, there are patients that seek amputation for CRPS that is refractory to treatment.…”

“…Dorsal column stimulation offers the advantage of providing a larger field of stimulation, has the most comprehensive MRI labeling and numerous options for energy delivery. Peripheral nerve and dorsal root ganglion stimulation (DRG‐s) are effective treatment modalities for focal neuropathic pain including complex regional pain syndrome (CRPS) that is limited to one or two dermatomes 2,4,15 . While a reduction in pain of fifty percent or greater is often deemed a satisfactory response in the treatment of chronic pain, we describe a case were the patient sought amputation of her limb in the hopes a prosthetic extremity would provide improved function.…”