PERIPHERAL NERVE STIMULATION FOR ACUTE PAIN: A TARGETED, OPIOID-SPARING APPROACH IN MODERN PAIN MANAGEMENT

Amit Beniwal MD, Edgar Remotti MD, FangyuChen MD, Lei Lu MD, Shiri Savir MD, Stephanie Wahab MD, Parker Woolley MD, Crystal Joseph MD, Victoria Buckman MD, Rahul Reddy MD, Sahil Amin MD

Peripheral nerve stimulation (PNS): studied and validated treatment for chronic pain conditions (neuropathic and complex regional pain syndromes) via targeted electrical stimulation to peripheral nerves.

inhibition of nociceptive signaling and neuromodulation of the peripheral nervous system

significant advantage: localized pain relief and reduced reliance on systemic medications

role of PNS in acute pain (postoperative pain), remains underexplored.

Acute pain (inadequately treated) can lead to:

delayed recovery

prolonged hospitalization

transition to chronic pain states.

Opioid epidemic: prompted need for alternatives to traditional pharmacologic approaches.

Recent technological advancements in percutaneous PNS systems:

safer, less invasive placement of stimulators, promising for acute pain management.

Highlights of the emerging evidence supporting the use of PNS for acute and postoperative pain as a potential asset in multimodal analgesia strategies:

A systematic review by Xu et al. (2021) assessed the efficacy of PNS in managing acute and chronic pain. The review included 227 studies and found Level IV evidence supporting the use of PNS in postsurgical pain management, indicating potential benefits in acute pain scenarios.

Ilfeld and Finneran (2020) conducted a narrative review focusing on cryoneurolysis and percutaneous PNS for acute pain. They reported that percutaneous PNS could provide postoperative analgesia without the side effects associated with opioids or local anesthetics, suggesting its utility in acute postoperative pain management.

A randomized controlled trial by Ilfeld et al. (2021) evaluated percutaneous PNS in patients undergoing ambulatory orthopedic surgery. The study demonstrated that active PNS significantly reduced pain scores and opioid consumption during the first postoperative week compared to sham treatment, highlighting its effectiveness in acute postoperative pain control.

PNS application in acute and postoperative pain management represents an important and innovative paradigm shift.

Mechanism by which PNS modulates pain makes it well-suited for acute pain scenarios.

Opioid-sparing techniques are increasingly prioritized, where multimodal approaches to acute pain are essential for improving outcomes and patient safety.

PNS may reduce the risk of acute pain transitioning into chronic pain (after surgery or trauma due to central sensitization).

Percutaneous nature of modern PNS systems: minimally invasive placement, feasible intervention for postoperative patients/acute pain settings, including emergency departments and trauma centers.

Despite promising results need for further high-quality RCTS to establish standardized parameters, refine patient selection criteria, and assess long-term outcomes.

Growing body of evidence suggests PNS could play a transformative role in the acute pain management landscape, filling a critical gap with a safe, effective, and opioid-sparing intervention.