OBJECTIVE: To conduct a systematic literature review of peripheral nerve stimulation (PNS) for pain.
DESIGN: Grade the evidence for PNS.
METHODS: An international interdisciplinary work group conducted a literature search for PNS. Abstracts were reviewed to select studies for grading. Inclusion/exclusion criteria included prospective randomized controlled trials (RCTs) with meaningful clinical outcomes that were not part of a larger or previously reported group. Excluded studies were retrospective, had less than two months of follow-up, or existed only as abstracts. Full studies were graded by two independent reviewers using the modified Interventional Pain Management Techniques-Quality Appraisal of Reliability and Risk of Bias Assessment, the Cochrane Collaborations Risk of Bias assessment, and the US Preventative Services Task Force level-of-evidence criteria.
RESULTS: Peripheral nerve stimulation was studied in 14 RCTs for a variety of painful conditions (headache, shoulder, pelvic, back, extremity, and trunk pain). Moderate to strong evidence supported the use of PNS to treat pain.
CONCLUSION: Peripheral nerve stimulation has moderate/strong evidence. Additional prospective trials could further refine appropriate populations and pain diagnoses.
The studies were not large. A weakness was difficulty in blinding the subjects.
This manuscript includes a variety of trials on different pain syndromes in different locations. The authors use strict criteria for inclusion, but this is an assembly of individual studies, not an analysis. Taken as a whole, the results support considering nerve stimulation for a subset of patients who have failed other therapies.