Effects of Ultrasound-Guided Nerve Stimulation Targeting Peripheral Nerve Tissue on Pain and Function: A Scoping Review

Abstract

This paper assesses the effects of percutaneous electrical nerve stimulation (PENS) on pain- and function-related outcomes by means of a scoping review of studies with single cases, case-series, quasi-experimental, and randomized or non-randomized trial designs. We consulted the PubMed, MEDLINE and EMBASE databases. Data were extracted by two reviewers. The methodological quality of studies was assessed using the Physiotherapy Evidence Database (PEDro) scale for experimental studies and the Joanna Briggs Institute (JBI) tool for case reports or cases series. Mapping of the results included: (1), description of included studies; (2), summary of results; and, (3), identification of gaps in the existing literature. Eighteen articles (five randomized controlled trials, one trial protocol, nine case series and three case reports) were included. The methodological quality of the papers was moderate to high. The conditions included in the studies were heterogeneous: chronic low back pain, lower limb pain after lumbar surgery, chronic post-amputation pain, rotator cuff repair, foot surgery, knee arthroplasty, knee pain, brachial plexus injury, elbow pain and ankle instability. In addition, one study included a healthy athletic population. Interventions were also highly heterogeneous in terms of sessions, electrical current parameters, or time of treatment. Most studies observed positive effects of PENS targeting nerve tissue against the control group; however, due to the heterogeneity in the populations, interventions, and follow-up periods, pooling analyses were not possible. Based on the available literature, PENS interventions targeting peripheral nerves might be considered as a potential therapeutic strategy for improving pain-related and functional outcomes. Nevertheless, further research considering important methodological quality issues (e.g., inclusion of control groups, larger sample sizes and comparatives between electric current parameters) are needed prior to recommending its use in clinical practice.

Ultrasound‐guided percutaneous electrical nerve stimulation versus surgery for women with unilateral carpal tunnel syndrome: A randomized parallel‐group trial

“…These results should be considered under the premise that most conservative therapeutic approaches are based on traditional clinical reasoning that considers CTS just as a localized pathology associated with a lesion at the carpal tunnel and, therefore, most treatments are local, for example, splints, ultrasound, low‐level laser, TENS or corticoid injections. A scoping review found that application of PENS seems to be effective for different chronic pain conditions such as low back pain, rotator cuff repair, knee pain, elbow pain or ankle instability (García‐Collado et al, 2022). The current study increases evidence supporting the effects of PENS (applied to the median nerve) on a neuropathic pain condition such as CTS.…”

“…Although discussing the underlying mechanisms associated with PENS is beyond the scope of this study, some hypotheses can be proposed. First, it is possible that PENS could reduce nerve excitability (the median nerve) by altering nociceptive input and reducing neurogenic inflammation or ectopic discharge (García‐Collado et al, 2022). A recent meta‐analysis has concluded that PENS seems to be able to modulate altered pain processing by decreasing pain sensitivity and activating conditioning pain modulation, although further studies are needed to confirm this (Lagos et al, 2022).…”

“…The application of PENS nearby to peripheral nerve trunks, an intervention also called percutaneous neuromodulation, has shown promising results in some musculoskeletal conditions (Fidalgo‐Martin et al, 2022). However, most studies have included patients with pain of musculoskeletal origins such as low back pain or knee pain (García‐Collado et al, 2022). No study investigating the effects of PENS for treatment of neuropathic pain of the upper extremity such as carpal tunnel syndrome is still available (García‐Collado et al, 2022).…”

“…However, most studies have included patients with pain of musculoskeletal origins such as low back pain or knee pain (García‐Collado et al, 2022). No study investigating the effects of PENS for treatment of neuropathic pain of the upper extremity such as carpal tunnel syndrome is still available (García‐Collado et al, 2022).…”

Inclusion of cross‐sectional and radiological images for better understanding of musculoskeletal anatomy and decreasing the risk of adverse events during dry needling in undergraduate physiotherapy students

“…32 However, since the use of US by physiotherapist got popular from 2006 after exploring the US utility for physiotherapists during the first Rehabilitative Ultrasound Imaging Symposium celebrated in Texas, 33 the inclusion of radiological education in physiotherapy undergraduate students is relatively novel compared with medical students. The use of radiological images as a complement for cross-sectional images may assist physiotherapy students in radiological identification of musculoskeletal structures while performing the clinical assessments (e.g., identifying the affected structures) or other invasive ultrasound-guided procedures placing the tip of the needle in the exact nerve branch or the exact tissular damage location (e.g., percutaneous electrical nerve stimulation 34 or percutaneous electrolysis 35 ). Yet, after a search in different databases [Medline® and PubMed (United States National Library of Medicine, National Institutes of Health, Bethesda, MD), Scopus® (Elsevier Inc., Amsterdam, The Netherlands), and Web of Science (Clarivate Analytics, Philadelphia, PA)] regarding the inclusion of cross-sectional and radiological images in undergraduate physiotherapy students, any study tested whether this methodology improves the students' anatomy and radiology understanding or assists the students in identifying high-risk structures during invasive procedures.…”