A review of the bioelectronic implications of stimulation of the peripheral nervous system for chronic pain conditions

Timothy R Deer, Ramana Naidu, Natalie Strand, Dawn Sparks, Alaa Abd-Elsayed, Hemant Kalia, Jennifer M Hah, Pankaj Mehta, Dawood Sayed, Amitabh Gulati, Timothy R Deer, Ramana Naidu, Natalie Strand, Dawn Sparks, Alaa Abd-Elsayed, Hemant Kalia, Jennifer M Hah, Pankaj Mehta, Dawood Sayed, Amitabh Gulati

Abstract

Background: Peripheral Nerve Stimulation has been used to treat human disease including pain for several decades. Innovation has made it a more viable option for treatment of common chronic pain processes, and interest in the therapy is increasing.

Main body: While clinical data is forthcoming, understanding factors that influence successful outcomes in the use of PNS still needs to be delineated. This article reviews the evolution and bioelectronic principles of peripheral nerve stimulation including patient selection, nerve targets, techniques and guidance of target delivery. We collate the current evidence for outcomes and provide recommendations for salient topics in PNS.

Conclusion: Peripheral nerve stimulation has evolved from a surgically invasive procedure to a minimally invasive technique that can be used early in the treatment of peripheral nerve pain. This review identifies and addresses many of the variables which influence the success of PNS in the clinical setting.

Keywords: Chronic pain; Neurostimulation; Peripheral nerve; Review; Ultrasound guidance.

Conflict of interest statement

Competing interestsTRD: consultant for Axonics, Abbott, Nalu, Saluda, Medtronic, Nevro, Boston Scientific (Vertiflex), Vertos, Cornerloc, SPR Therapeutics, Flowonix. Stimgenics. RKN: Consultant for Abbott, Avanos, Bicycle Health, Boston Scientific, CereVu, ExerAI, KarunaVR, Nalu, Omnia Medical, Sonosite, SPR Therapeutics, Vertiflex, Vertos. NHS: nothing to declare. DS: nothing to declare. AA: consultant for Medtronic, StimWave, Avanos and Sollis. JMH: Nothing to declare. HK: nothing to declare. PM: Consultant for Abbott, CornerLoc SPR Therapeutics, Vertiflex, Ethos Labs. DS: Abbott, Flowonix, Medtronic, Nevro, PainTeq, SPR, Stimgenics, Vertos, Vertiflex. AG: Consultant for Medtronic, Flowonix, AIS, SPR Therapeutics, Nalu, EnsoRelief.

© The Author(s) 2020.

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