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Peripheral Nerve Stimulation for Chronic Pain: A Systematic Review of Effectiveness and Safety
Peripheral nerve stimulation (PNS) was the first application of neuromodulation. Widespread application of PNS was limited by technical concerns. Recent advances now allow the percutaneous placement of leads with ultrasound or fluoroscopic guidance, while the transcutaneous powering of these leads r...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Healthcare
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8586061/ https://www.ncbi.nlm.nih.gov/pubmed/34478120 http://dx.doi.org/10.1007/s40122-021-00306-4 |
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author | Helm, Standiford Shirsat, Nikita Calodney, Aaron Abd-Elsayed, Alaa Kloth, David Soin, Amol Shah, Shalini Trescot, Andrea |
author_facet | Helm, Standiford Shirsat, Nikita Calodney, Aaron Abd-Elsayed, Alaa Kloth, David Soin, Amol Shah, Shalini Trescot, Andrea |
author_sort | Helm, Standiford |
collection | PubMed |
description | Peripheral nerve stimulation (PNS) was the first application of neuromodulation. Widespread application of PNS was limited by technical concerns. Recent advances now allow the percutaneous placement of leads with ultrasound or fluoroscopic guidance, while the transcutaneous powering of these leads removes the need for leads to cross major joints. This systematic review was written to assess the current status of high-quality evidence supporting the use of PNS for pain conditions treated by interventional pain physicians. The available literature on PNS, limited to conditions treated by interventional pain physicians, was reviewed and the quality assessed. Literature from 1966 to June 2021 was reviewed. The outcome measures were pain relief and functional improvement. One hundred and two studies were identified. Five randomized controlled trials (RCT) and four observational studies, all case series, met the inclusion criteria. One RCT was of high quality and four were of moderate quality; all four case series were of moderate quality. Three of the RCTs and all four case series evaluated peripheral nerve neuropathic pain. Based upon these studies, there is level II evidence supporting the use of PNS to treat refractory peripheral nerve injury. One moderate-quality RCT evaluated tibial nerve stimulation for pelvic pain, providing level III evidence for this indication. One moderate-quality RCT evaluated surgically placed cylindrical leads for cluster headaches, providing level III evidence for this indication. The evidence suggests that approximately two-thirds of patients with peripheral neuropathic pain will have at least 50% sustained pain relief. Adverse events from PNS are generally minor. A major advantage of PNS over spinal cord stimulation is the absence of any risk of central cord injury. The study was limited by the paucity of literature for some indications. No studies dealt with joint-related osteoarthritic pain. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40122-021-00306-4. |
format | Online Article Text |
id | pubmed-8586061 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Springer Healthcare |
record_format | MEDLINE/PubMed |
spelling | pubmed-85860612021-11-15 Peripheral Nerve Stimulation for Chronic Pain: A Systematic Review of Effectiveness and Safety Helm, Standiford Shirsat, Nikita Calodney, Aaron Abd-Elsayed, Alaa Kloth, David Soin, Amol Shah, Shalini Trescot, Andrea Pain Ther Review Peripheral nerve stimulation (PNS) was the first application of neuromodulation. Widespread application of PNS was limited by technical concerns. Recent advances now allow the percutaneous placement of leads with ultrasound or fluoroscopic guidance, while the transcutaneous powering of these leads removes the need for leads to cross major joints. This systematic review was written to assess the current status of high-quality evidence supporting the use of PNS for pain conditions treated by interventional pain physicians. The available literature on PNS, limited to conditions treated by interventional pain physicians, was reviewed and the quality assessed. Literature from 1966 to June 2021 was reviewed. The outcome measures were pain relief and functional improvement. One hundred and two studies were identified. Five randomized controlled trials (RCT) and four observational studies, all case series, met the inclusion criteria. One RCT was of high quality and four were of moderate quality; all four case series were of moderate quality. Three of the RCTs and all four case series evaluated peripheral nerve neuropathic pain. Based upon these studies, there is level II evidence supporting the use of PNS to treat refractory peripheral nerve injury. One moderate-quality RCT evaluated tibial nerve stimulation for pelvic pain, providing level III evidence for this indication. One moderate-quality RCT evaluated surgically placed cylindrical leads for cluster headaches, providing level III evidence for this indication. The evidence suggests that approximately two-thirds of patients with peripheral neuropathic pain will have at least 50% sustained pain relief. Adverse events from PNS are generally minor. A major advantage of PNS over spinal cord stimulation is the absence of any risk of central cord injury. The study was limited by the paucity of literature for some indications. No studies dealt with joint-related osteoarthritic pain. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40122-021-00306-4. Springer Healthcare 2021-09-03 2021-12 /pmc/articles/PMC8586061/ /pubmed/34478120 http://dx.doi.org/10.1007/s40122-021-00306-4 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by-nc/4.0/Open Access This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Review Helm, Standiford Shirsat, Nikita Calodney, Aaron Abd-Elsayed, Alaa Kloth, David Soin, Amol Shah, Shalini Trescot, Andrea Peripheral Nerve Stimulation for Chronic Pain: A Systematic Review of Effectiveness and Safety |
title | Peripheral Nerve Stimulation for Chronic Pain: A Systematic Review of Effectiveness and Safety |
title_full | Peripheral Nerve Stimulation for Chronic Pain: A Systematic Review of Effectiveness and Safety |
title_fullStr | Peripheral Nerve Stimulation for Chronic Pain: A Systematic Review of Effectiveness and Safety |
title_full_unstemmed | Peripheral Nerve Stimulation for Chronic Pain: A Systematic Review of Effectiveness and Safety |
title_short | Peripheral Nerve Stimulation for Chronic Pain: A Systematic Review of Effectiveness and Safety |
title_sort | peripheral nerve stimulation for chronic pain: a systematic review of effectiveness and safety |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8586061/ https://www.ncbi.nlm.nih.gov/pubmed/34478120 http://dx.doi.org/10.1007/s40122-021-00306-4 |
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