Percutaneous electrical nerve stimulation (PENS) for refractory neuropathic pain

• percutaneous electrical nerve stimulation for refractory neuropathic pain
  • NICE support the use of this technology and state that:
    • "..current evidence on the safety of percutaneous electrical nerve stimulation (PENS) for refractory neuropathic pain raises no major safety concerns and there is evidence of efficacy in the short term. Therefore this procedure may be used with normal arrangements for clinical governance, consent and audit
    • patient selection and treatment using PENS for refractory neuropathic pain should be carried out by teams specialising in pain management..."
      
      
  • what is PENS?
    • in PENS, 1 or more individual nerves or dermatomes are stimulated using needle probes
    • a single probe with a grounding pad or pairs of fine-gauge needles are inserted into soft tissue near the targeted nerves or into the affected dermatomes
    • needles are connected to a low-voltage pulse generator and an electrical current is then applied. This may generate a sensation of paraesthesia and muscle contraction
    • duration of treatment varies but each session of stimulation typically lasts between 15 and 60 minutes
      
      
    • safety and adverse effects:
      • NICE list exacerbation of pain, bruising and bleeding as anecdotal adverse events
        • listed theoretical adverse events as vascular damage; damage to local nerves with sequelae, depending on which nerve was damaged; pneumothorax; possible interaction with a cardiac pacemaker if used above the waistline; possible epileptogenic effect if used near the head; possible effects if used in pregnancy; dislodgement (with loss of effect); unpleasant paraesthesias; and local bruising or haematoma
          
          
    • difference between PENS and TENS (transcutaneous electrical nerve stimulation)
      • TENS is a non-invasive therapeutic option, generally used to relieve pain, which uses peripheral nerve electrical stimulation by means of electrodes placed on the skin surface at known well-tolerated intensities
      • PENS, on the other hand, uses needle-like electrodes, similar to those used in acupuncture which are 1-4 cm long, located in soft tissues or muscles at the corresponding dermatomes for that local pathology

Reference:

• (1) NICE (March 2013). Percutaneous electrical nerve stimulation for refractory neuropathic pain