Background & Aims
Percutaneous peripheral nerve stimulation (pPNS) involves the minimally invasive application of electrical stimulation to a peripheral nerve, achieved through the insertion of an ultrasound-guided needle. In a clinical context, it is used in the management of conditions such as musculoskeletal, post-surgical or neuropathic pain. Physiologically, pPNS can modify pain and tactile sensitivity, producing hypoalgesia in the territory innervated by the stimulated nerve in healthy patients (Beltrá et al, 2022). As this has not been explored in pain suffering patients, this study aimed to investigate the therapeutic effects of two pPNS protocols designed to potentiate non-nociceptive circuits and determine whether they produce pain reduction and/or motor changes in patients with neck pain.
Methods
45 patients suffering from unspecific neck pain were assigned to one of the following three intervention groups (n per group = 15): percutaneous high-frequency stimulation (pHFS), percutaneous theta-burst stimulation (pTBS) and transcutaneous electrical nerve stimulation (TENS). Stimulation was applied to the Spinal Nerve for the pPNS interventions and to the trapezius for the TENS group. A Numerical Pain Scale (verbal NRS) was used to assess subjects’ pain at rest, and pain evoked by movement. Maximal strength was measured along with the electromyographic signal of the upper trapezius muscle, under baseline conditions and immediately after treatment. Additionally, one week after treatment, the pain presented by the subjects was re-evaluated.
Results
The pHFS protocol was the only one that induced hypoalgesia both at rest (p < 0.001) and during movement (p = 0.01), while pTBS and TENS elicited hypoalgesia solely during movement (p < 0.001, p = 0.002, respectively). One-week post-treatment, the pPNS groups, pHFS and pTBS, exhibited a significant decrease in pain (p = 0.041, p <0.001) that was not occurring in the TENS group (p > 0.05). On the other hand, the pTBS and TENS protocols produced a significant increase in strength after treatment (p = 0.021, p = 0.019), although no differences in muscle recruitment were observed in any of the groups.
Conclusions
The results presented here demonstrate that pPNS protocols designed to induce neural plasticity can be translated into the non-pharmacological treatment of pain, offering greater outcomes than classical therapeutic stimulation paradigms. Moreover, pPNS protocols can induce changes in motor function depending on their parameterization.
References
Beltrá, P., Ruiz-del-Portal, I., Ortega, F. J., Valdesuso, R., Delicado-Miralles, M., & Velasco, E. (2022). Sensorimotor effects of plasticity-inducing percutaneous peripheral nerve stimulation protocols: a blinded, randomized clinical trial. European Journal of Pain, 00, 1–17.
Presenting Author
Maria José Giner García
Poster Authors
Maria José Giner García
MSc
Instituto de Neurociencias de Alicante
Lead Author
Topics
- Specific Pain Conditions/Pain in Specific Populations: Neck Pain