Jijun Xu1, Zhuo Sun2, Jiang Wu3, Maunak Rana4, Joshua Garza4, Alyssa C Zhu5, Krishnan V Chakravarthy5, Alaa Abd-Elsayed6, Ellen Rosenquist7, Hersimren Basi8, Paul Christo9, Jianguo Cheng7. 1. Department of Pain Management, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH; Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH; Department of Anesthesiology, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH. 2. Department of Anesthesiology and Perioperative Medicine, Augusta University Medical Center, Medical College of Georgia, Augusta, GA. 3. Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, WA. 4. Department of Anesthesiology and Critical Care, The University of Chicago, Chicago, IL. 5. Department of Anesthesiology and Pain Medicine, University of California San Diego, VA San Diego Healthcare System, La Jolla, CA. 6. Department of Anesthesiology University of Wisconsin, School of Medicine and Public Health, Madison, WI. 7. Cleveland Clinic, Cleveland, OH. 8. Department of Pain Management, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH. 9. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Blaustein Pain Treatment Center, Johns Hopkins Hospital, Baltimore MD.
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.
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.
Authors: Richard L Rauck; Leonardo Kapural; Steven P Cohen; James M North; Christopher A Gilmore; Rosemary H Zang; Joseph W Boggs Journal: Pain Pract Date: 2012-05-02 Impact factor: 3.183
Authors: Louis P Vera-Portocarrero; Toni Cordero; Tina Billstrom; Kim Swearingen; Paul W Wacnik; Lisa M Johanek Journal: Neuromodulation Date: 2013-02-26
Authors: Pablo Castroman; Ovelio Quiroga; Victor Mayoral Rojals; Maria Gómez; Eleni Moka; Joseph Pergolizzi; Giustino Varrassi Journal: Cureus Date: 2022-04-09
Authors: Selina Johnson; Anne Marshall; Walter Magerl; Andreas Goebel; Dyfrig Hughes; Emily Holmes; Florian Henrich; Turo Nurmikko; Manohar Sharma; Bernhard Frank; Paul Bassett; Andrew Marshall Journal: J Transl Med Date: 2021-11-06 Impact factor: 5.531