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

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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.

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Most cited references 79

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A peripheral mononeuropathy in rat that produces disorders of pain sensation like those seen in man

Gary J Bennett, Y.-K. Xie (1988)

A peripheral mononeuropathy was produced in adult rats by placing loosely constrictive ligatures around the common sciatic nerve. The postoperative behavior of these rats indicated that hyperalgesia, allodynia and, possibly, spontaneous pain (or dysesthesia) were produced. Hyperalgesic responses to noxious radiant heat were evident on the second postoperative day and lasted for over 2 months. Hyperalgesic responses to chemogenic pain were also present. The presence of allodynia was inferred from the nocifensive responses evoked by standing on an innocuous, chilled metal floor or by innocuous mechanical stimulation, and by the rats' persistence in holding the hind paw in a guarded position. The presence of spontaneous pain was suggested by a suppression of appetite and by the frequent occurrence of apparently spontaneous nocifensive responses. The affected hind paw was abnormally warm or cool in about one-third of the rats. About one-half of the rats developed grossly overgrown claws on the affected side. Experiments with this animal model may advance our understanding of the neural mechanisms of neuropathic pain disorders in humans.

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A review of chronic pain impact on patients, their social environment and the health care system

Maria Dueñas, Begoña Ojeda, Alejandro Salazar … (2016)

Chronic pain (CP) seriously affects the patient’s daily activities and quality of life, but few studies on CP have considered its effects on the patient’s social and family environment. In this work, through a review of the literature, we assessed several aspects of how CP influences the patient’s daily activities and quality of life, as well as its repercussions in the workplace, and on the family and social environment. Finally, the consequences of pain on the health care system are discussed. On the basis of the results, we concluded that in addition to the serious consequences on the patient’s life, CP has a severe detrimental effect on their social and family environment, as well as on health care services. Thus, we want to emphasize on the need to adopt a multidisciplinary approach to treatment so as to obtain more comprehensive improvements for patients in familial and social contexts. Accordingly, it would be beneficial to promote more social- and family-oriented research initiatives.

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Evaluation and management of peripheral nerve injury.

William W Campbell (2008)

Common etiologies of acute traumatic peripheral nerve injury (TPNI) include penetrating injury, crush, stretch, and ischemia. Management of TPNI requires familiarity with the relevant anatomy, pathology, pathophysiology, and the surgical principles, approaches and concerns. Surgical repair of TPNI is done at varying time intervals after the injury, and there are a number of considerations in deciding whether and when to operate. In neurapraxia, the compound muscle and nerve action potentials on stimulating distal to the lesion are maintained indefinitely; stimulation above the lesion reveals partial or complete conduction block. The picture in axonotmesis and neurotmesis depends on the time since injury. The optimal timing for an electrodiagnostic study depends upon the clinical question being asked. Although conventional teaching usually holds that an electrodiagnostic study should not be done until about 3 weeks after the injury, in fact a great deal of important information can be obtained by studies done in the first week. Proximal nerve injuries are problematic because the long distance makes it difficult to reinnervate distal muscles before irreversible changes occur. Decision making regarding exploration must occur more quickly, and exploration using intraoperative nerve action potential recording to guide the choice of surgical procedure is often useful.

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Author and article information

Contributors

Timothy R. Deer: doctdeer@aol.com

Journal

Journal ID (nlm-ta): Bioelectron Med

Journal ID (iso-abbrev): Bioelectron Med

Title: Bioelectronic Medicine

Publisher: BioMed Central (London )

ISSN (Electronic): 2332-8886

Publication date (Electronic): 24 April 2020

Publication date PMC-release: 24 April 2020

Publication date Collection: 2020

Volume: 6

Electronic Location Identifier: 9

Affiliations

Spine and Nerve Center for the Virginias, 400 Court Street, Suite 100, Charleston, West Virginia 25301 USA

Article

Publisher ID: 45

DOI: 10.1186/s42234-020-00045-5

PMC ID: 7181529

PubMed ID: 32346553

SO-VID: b84203ac-b176-475b-a8fb-dbdbfacbcb3b

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits 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/4.0/.

History

Date received : 23 December 2019

Date accepted : 24 March 2020

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Keywords: peripheral nerve,neurostimulation,review,chronic pain,ultrasound guidance

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Keywords: peripheral nerve, neurostimulation, review, chronic pain, ultrasound guidance

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

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Abstract

Background

Main body

Conclusion

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Most cited references 79

A peripheral mononeuropathy in rat that produces disorders of pain sensation like those seen in man

A review of chronic pain impact on patients, their social environment and the health care system

Evaluation and management of peripheral nerve injury.

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