Percutaneous Electrical Nerve Stimulation As Alternative To Nerve Blocks In Anesthesia, Pain Medicine And Rehabilitation Of Nonspecific Chronic Pain
Summary
Chronic musculoskeletal pain of non-specific origin affects approximately 30% of the global population. Beyond its prevalence, it represents a serious health and socioeconomic problem. It is considered the leading cause of years lived with disability and is characterized by persistent functional limitation, deterioration of quality of life, and poorer mental health, with a high comorbidity of depression, anxiety, and sleep disorders, as well as a greater risk of suicidal ideation and behavior. From a socioeconomic perspective, chronic pain entails an impact of up to USD 635 billion annually just in United States (USA). In fact, spinal pain alone represents the condition with the highest direct costs (around USD 134.5 billion in USA) and additional indirect costs due to absenteeism and presenteeism, which impair productivity and work performance. These figures are expected to be substantially higher when considered at a global scale. One of the main aggravating factors of this condition is that in up to 90% of patients experiencing pain there is no identifiable anatomopathological substrate that reliably explains the symptoms (non-specific pain). Radiological findings are extremely common in asymptomatic populations, and making diagnostic or therapeutic decisions based on such findings, promotes overdiagnosis and low-value clinical cascades. It is estimated that up to 50% of imaging requests and 60% of spinal surgeries6 are unnecessary or unjustified. For this reason, Clinical Practice Guidelines recommend prioritizing interventional diagnostic techniques based on functional criteria over the interpretation of radiological findings, as they allow for more sensitive and specific identification of nociceptive sources (with a recommendation grade I-II). In this context, the motivation of the project is to study PENS as a non-pharmacological, safe, and transferable alternative to nerve blocks, reducing the risk of complications associated with the use of local anesthetics/corticosteroids and large-gauge needles. According to recent systematic reviews and meta-analyses confirming immediate analgesic responses, PENS could be a feasible alternative that maintains functional diagnostic and therapeutic value with a generally mild adverse-event profile and lower cost.
Timeline
- Start
- 2026-09-01
- Primary completion
- 2028-11-01
- Completion
- 2029-08-31
Publications
- Results Valera-Calero JA, Plaza-Manzano G, Rabanal-Rodriguez G, Diaz-Arribas MJ, Kobylarz MD, Buffet-Garcia J, Fernandez-de-Las-Penas C, Navarro-Santana MJ. Current State of Dry Needling Practices: A Comprehensive Analysis on Use, Training, and Safety. Medicina (Kaunas). 2024 Nov 14;60(11):1869. doi: 10.3390/medicina60111869.
- Results Rabanal-Rodriguez G, Navarro-Santana MJ, Valera-Calero JA, Gomez-Chiguano GF, Kocot-Kepska M, Fernandez-de-Las-Penas C, Plaza-Manzano G. Neurophysiological Effects of Dry Needling: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil. 2026 Feb;107(2):299-314. doi: 10.1016/j.apmr.2025.08.019. Epub 2025 Sep 6.
- Results Mogedano-Cruz S, Lopez-Perez M, Gijon-Lago D, Romero-Morales C, Alonso-Perez JL, Villafane JH, Saiz SLJ, Sosa-Reina MD. Peripheral Percutaneous Electrical Nerve Stimulation for Neuropathies: A Systematic Review and Meta-analysis. Pain Manag Nurs. 2025 Feb;26(1):93-101. doi: 10.1016/j.pmn.2024.11.005. Epub 2024 Dec 13.
- Results Phan KH, Anderson JG, Bohay DR. Complications Associated with Peripheral Nerve Blocks. Orthop Clin North Am. 2021 Jul;52(3):279-290. doi: 10.1016/j.ocl.2021.03.007. Epub 2021 May 7.
- Results Hall AM, Aubrey-Bassler K, Thorne B, Maher CG. Do not routinely offer imaging for uncomplicated low back pain. BMJ. 2021 Feb 12;372:n291. doi: 10.1136/bmj.n291. No abstract available.
- Results Chou R, Fu R, Carrino JA, Deyo RA. Imaging strategies for low-back pain: systematic review and meta-analysis. Lancet. 2009 Feb 7;373(9662):463-72. doi: 10.1016/S0140-6736(09)60172-0.
- Results GBD 2021 Low Back Pain Collaborators. Global, regional, and national burden of low back pain, 1990-2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol. 2023 May 22;5(6):e316-e329. doi: 10.1016/S2665-9913(23)00098-X. eCollection 2023 Jun.
- Results Plaza-Manzano G, Gomez-Chiguano GF, Cleland JA, Arias-Buria JL, Fernandez-de-Las-Penas C, Navarro-Santana MJ. Effectiveness of percutaneous electrical nerve stimulation for musculoskeletal pain: A systematic review and meta-analysis. Eur J Pain. 2020 Jul;24(6):1023-1044. doi: 10.1002/ejp.1559. Epub 2020 Apr 4.
- Results Olivier TJ, Konda C, Pham T, Baltich Nelson B, Patel A, Sharma GS, Trivedi K, Annaswamy TM. Clinical practice guidelines on interventional management of low back pain: A synthesis of recommendations. PM R. 2023 Aug;15(8):1052-1063. doi: 10.1002/pmrj.12930.
- Results Busse JW, Genevay S, Agarwal A, Standaert CJ, Carneiro K, Friedrich J, Ferreira M, Verbeke H, Brox JI, Xiao H, Virdee JS, Gunderson J, Foster G, Heegsma C, Samer CF, Coen M, Guyatt GH, Wang X, Sadeghirad B, Malam F, Zeraatkar D, Vandvik PO, Zhou T, Xie F, Siemieniuk RAC, Agoritsas T. Commonly used interventional procedures for non-cancer chronic spine pain: a clinical practice guideline. BMJ. 2025 Feb 19;388:e079970. doi: 10.1136/bmj-2024-079970.
- Results Manchikanti L, Kaye AD, Soin A, Albers SL, Beall D, Latchaw R, Sanapati MR, Shah S, Atluri S, Abd-Elsayed A, Abdi S, Aydin S, Bakshi S, Boswell MV, Buenaventura R, Cabaret J, Calodney AK, Candido KD, Christo PJ, Cintron L, Diwan S, Gharibo C, Grider J, Gupta M, Haney B, Harned ME, Helm Ii S, Jameson J, Jha S, Kaye AM, Knezevic NN, Kosanovic R, Manchikanti MV, Navani A, Racz G, Pampati V, Pasupuleti R, Philip C, Rajput K, Sehgal N, Sudarshan G, Vanaparthy R, Wargo BW, Hirsch JA. Comprehensive Evidence-Based Guidelines for Facet Joint Interventions in the Management of Chronic Spinal Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines Facet Joint Interventions 2020 Guidelines. Pain Physician. 2020 May;23(3S):S1-S127.
- Results AlAli KF. Unnecessary spine surgery: can we solve this ongoing conundrum? Front Surg. 2023 Aug 25;10:1270975. doi: 10.3389/fsurg.2023.1270975. eCollection 2023. No abstract available.
- Results Logan GS, Pike A, Copsey B, Parfrey P, Etchegary H, Hall A. What do we really know about the appropriateness of radiation emitting imaging for low back pain in primary and emergency care? A systematic review and meta-analysis of medical record reviews. PLoS One. 2019 Dec 5;14(12):e0225414. doi: 10.1371/journal.pone.0225414. eCollection 2019.
- Results Jenkins HJ, Downie AS, Maher CG, Moloney NA, Magnussen JS, Hancock MJ. Imaging for low back pain: is clinical use consistent with guidelines? A systematic review and meta-analysis. Spine J. 2018 Dec;18(12):2266-2277. doi: 10.1016/j.spinee.2018.05.004. Epub 2018 May 3.
- Results Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet. 2017 Feb 18;389(10070):736-747. doi: 10.1016/S0140-6736(16)30970-9. Epub 2016 Oct 11.
- Results de Luca K, Tavares P, Yang H, Hurwitz EL, Green BN, Dale H, Haldeman S. Spinal Pain, Chronic Health Conditions and Health Behaviors: Data from the 2016-2018 National Health Interview Survey. Int J Environ Res Public Health. 2023 Apr 3;20(7):5369. doi: 10.3390/ijerph20075369.
- Results Cohen SP, Vase L, Hooten WM. Chronic pain: an update on burden, best practices, and new advances. Lancet. 2021 May 29;397(10289):2082-2097. doi: 10.1016/S0140-6736(21)00393-7.
- Valera-Calero JA, Sanchez-Jorge S, Vicente-Campos D, Kosson D, Kolacz M, Kocot-Kepska M, Mieszczanski P, Lopez-Chicharro J, Varol U, Gorniewski G, Lopez-Redondo M, Kobylarz MD. Percutaneous electrical nerve stimulation as alternative to nerve blocks for the diagnosis of facet joint syndrome in patients with non-specific chronic low back pain: a clinical trial protocol. Pain Manag. 2026 Apr 15:1-7. doi: 10.1080/17581869.2026.2660325. Online ahead of print.
Drugs
| Evaluation | Drug | Modality | Dose | Route |
|---|---|---|---|---|
| Comparator | Lidocaine | Other / unclassified | 0.5 ml | Other |
| Comparator | Lidocaine | Other / unclassified | 1 % | Other |