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. 2021 Mar;24(2):E131-E152.

Peripheral Nerve Stimulation in Pain Management: A Systematic Review

Jijun Xu  1 , Zhuo Sun  2 , Jiang Wu  3 , Maunak Rana  4 , Joshua Garza  4 , Alyssa C Zhu  5 , Krishnan V Chakravarthy  5 , Alaa Abd-Elsayed  6 , Ellen Rosenquist  7 , Hersimren Basi  8 , Paul Christo  9 , Jianguo Cheng  7
Affiliations

Peripheral Nerve Stimulation in Pain Management: A Systematic Review

Jijun Xu et al. Pain Physician. 2021 Mar.

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.

Keywords: chronic pain; neuromodulation; peripheral nerve stimulation; Acute pain.

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Conflict of interest statement

Conflict of interest: Krishnan V. Chakravarthy is a founder of Douleur Therapeutics, Newrom Biomedical, and a consultant for Abbott, Medtronic, Boston Scientific, Medincell, Omnia Medical, and Bioness. He has stock options in Nalu Medical, Higgs Boson Health, and Oska Wellness. Alaa Abd-Elsayed is a consultant for Medtronic and Avanos. Paul Christo is a consultant for Daiichi Sankyo and GlaxoSmithKline..

Figures

Fig. 1.
Fig. 1.
PNS in pain management: PRISMA flow diagram.
See this image and copyright information in PMC

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