Article
Peripheral nerve field stimulation (PNFS) for chronic lumbar pain and the predictive value of transcutaneous electrical nerve stimulation (TENS) for patient selection
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Authors
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Frank Schwarm
- Justus-Liebig-Universität Gießen, Klinik für Neurochirurgie, Gießen, Deutschland
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Marc Ott
- Justus-Liebig-Universität Gießen, Klinik für Neurochirurgie, Gießen, Deutschland
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Enea Thanasi
- Justus-Liebig-Universität Gießen, Klinik für Neurochirurgie, Gießen, Deutschland
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Michael Worsch
- Justus-Liebig-Universität Gießen, Klinik für Neurochirurgie, Gießen, Deutschland
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Marco Stein
- Justus-Liebig-Universität Gießen, Klinik für Neurochirurgie, Gießen, Deutschland
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Eberhard Uhl
- Justus-Liebig-Universität Gießen, Klinik für Neurochirurgie, Gießen, Deutschland
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Malgorzata Kolodziej
- Justus-Liebig-Universität Gießen, Klinik für Neurochirurgie, Gießen, Deutschland
| Published: | June 18, 2018 |
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Outline
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Objective: PNFS is an effective alternative treatment for patients withchronic low back pain. TENS is known for easy application and frequently used in pain therapy. Aim of this prospective study was to examine the predictive value of TENS treatment for later successful PNFS.
Methods: Between 2014 and 2017 a prospective cohort study of 23 patients with chronic lumbar pain was conducted. All patients were treated with multiple pain medications. Pain intensity (NRS), SF12v2 with Physical Component Summary (PCS) and Mental Component Summary (MCS) scores, as well as Oswestry Disability Index (ODI) were assessed before and after TENS use, pre- and postoperatively as well as 3 and 6 months after PFNS implantation. TENS was applied for 3-5 days. The implantation of a rechargeable PNFS-system with 2 percutaneous leads was performed after 4-7 days of positive testing. Statistical analysis was performed using the Mann-Whitney U and the Wilcoxon rank-sum test.
Results: The cohort consisted of 23 patients (9 females, 14 males) with a median age of 60.9 years (IQR25-75 52.6-65.7). After positive PNFS testing, a neurostimulator was implanted in 8 patients with positive TENS effect and 10 patients with no TENS effect. 5 patients had no PNFS effect and the test electrode was explanted. After 3 and 6 months median NRS was reduced from 8.5 (IQR25-75 7-9) to 2.5 (IQR25-75 0-3.8; p=0.001) and 3.0 (IQR25-75 2.3-3.8; p=0.001), ODI from 57.0 (IQR25-75 46.5-66) to 38.0 (IQ IQR25-75 19-51; p=0.01) and 34.0 (IQR25-75 15-49; p=0.01) in the TENS positive cohort, respectively. The TENS negative cohort showed a median NRS reduction from 7.0 (IQR25-75 6-8) to 5.0 (IQR25-75 3-6.5; p=0.010) and 4.0 (IQR25-75 3.0-7.3; p=0.018), after 3 and 6 months, respectively. There was no improvement from initial ODI 45.0 (IQR25-75 44.0-62.5) neither after 3 nor after 6 months. Generic health survey scores (PCS and MCS domains of the SF-12v2) showed a slight improvement in the TENS positive cohort. All patients with negative PNFS testing belonged to the TENS negative cohort.
Conclusion: TENS can be a predictive tool for patient selection in PNFS, as TENS positive patients showed a significantly better treatment effect after PNFS implantation. PNFS itself is an effective and safe treatment for chronic low back pain.
