Effect of percutaneous electrical nerve field stimulation on mechanosensitivity, sleep, and psychological comorbidities in adolescents with functional abdominal pain disorders

Abstract

Background Percutaneous electrical nerve field stimulation (PENFS) improves symptoms in adolescents with functional abdominal pain disorders (FAPDs). However, little is known about its impact on sleep and psychological functioning. We evaluated the effects of PENFS on resting and evoked pain and nausea, sleep and psychological functioning, and long‐term outcomes. Methods Patient ages 11–19 years with FAPD requiring PENFS as standard care were recruited. Evoked pain was elicited by a Water Load Symptom Provocation Task (WL‐SPT) before and after four weeks of treatment. Pain, gastrointestinal symptoms, sleep, somatic symptoms, and physical and psychological functioning were assessed. Actigraphy was used to measure daily sleep–wake patterns. Key Results Twenty patients (14.3 ± 2.2 years old) with FAPD were enrolled. Most patients were females (70%) and white (95%). During pain evoked by WL‐SPT, visual analog scale (VAS) pain intensity and nausea were lower following PENFS compared with baseline (p = 0.004 and p = 0.02, respectively). After PENFS, resting VAS pain unpleasantness (p = 0.03), abdominal pain (p < 0.0001), pain catastrophizing (p = 0.0004), somatic complaints (0.01), functional disability (p = 0.04), and anxiety (p = 0.02) exhibited significant improvements, and some were sustained long‐term. Self‐reported sleep improved after PENFS (p's < 0.05) as well as actigraphy‐derived sleep onset latency (p = 0.03). Conclusions and Inferences We demonstrated improvements in resting and evoked pain and nausea, sleep, disability, pain catastrophizing, somatic complaints, and anxiety after four weeks of PENFS therapy. Some effects were sustained at 6–12 months post‐treatment. This suggests that PENFS is a suitable alternative to pharmacologic therapy.

Klinische Wirksamkeit der aurikulären Vagusnervstimulation in der Behandlung chronischer und akuter Schmerzen

“…1 -und Kontrolle), Stimulationsparameter, Behandlungsdauer, primäre und sekundäre Ergebnisse sowie beobachtete unerwünschte Ereignisse. [30,40,41,49,53,64,69], n = 154), Migräne (4 Studien [24,39,70,84], n = 133), Rückenschmerz (4 Studien [39,65,66,71], n = 192), rheumatoide Arthritis (RA)/Osteoarthritis (2 Studien [17,46]; n = 45), Fibromyalgie/ systemischer Lupus Erythematodes (SLE) (3 Studien [5,43,79], n = 51), Chemotherapie-induzierte periphere Neuropathie (1 Studie [62]; n = 58), unspezifischer chronischer Schmerz (1 Studie [30], n = 3). Von diesen waren 9 Studien [5,40,41,43,65,66,69,70,84] Schmerz auf einer Visuellen Analogskala (VAS) oder Numerischen Rating-Skala (NRS), psychisches Wohlbefinden und Verträglichkeit/Sicherheit der Stimulation waren die häufigsten primären und sekundären Endpunkte.…”

Emerging noninvasive neuromodulation methods for functional gastrointestinal diseases

“…The safety profile of taVNS is excellent as none of these studies reported side effects. paVNS via 2 mm needle electrodes was reported to improve abdominal pain in adolescents with FGIDs (60 patients with active treatment and 55 with sham treatment), [9] resting and evoked pain in 20 adolescents with functional abdominal pain disorders, [10] and symptoms of IBS in 50 adolescents with IBS. [11] In these studies, the therapy was delivered as follows.…”

“…Advantages Disadvantages taVNS [6][7][8] Auricular vagus nerve via surface electrodes 1-100 Hz FD, IBS Self-administered; home based Daily placement of electrodes paVNS [9][10][11] Auricular vagus nerve via needles 1-100 Hz Pediatric abdominal pain, IBS Device attached to the ear Needle penetration; long stimulation duration tcVNS [12][13] Cervical vagus nerve via surface electrodes 5 kHz Gastroparesis Short study duration (a few minutes)…”

Pediatric gastrointestinal neuromodulation: A review

“…In our recent study in 20 adolescents aged 11–19 years with functional abdominal pain disorders (FAPD), we analyzed the effects of PENFS on gastric mechanosensitvity through a water load symptom provocation task (WL-SPT), sleep and psychological functioning, as well as long-term outcomes. [ 62 ] Evoked pain intensity and nausea during WL-SPT were lower following PENFS compared to baseline ( P = 0.004 and P = 0.02 respectively). Self-reported sleep quality, insomnia severity, sleep disturbance, and sleep-related impairment improved after PENFS ( P 's < 0.05) as well as actigraghy-derived sleep onset latency ( P = 0.03).…”