Journal Club - PNS for axial low back pain, impact on pain chronification

Spine & Nerve

In this week's episode of the Spine & Nerve Podcast, Drs. Nicolas Karvelas and Brian Joves build on last week's episode on pain chronification and discuss a promising therapy for chronic axial low back pain: Peripheral Nerve Stimulation (PNS). PNS is an implanted device (in our discussion, a temporary implant for 60 days) that uses therapeutic electrical stimulation to target specific peripheral nerves, such as the medial branch of the dorsal ramus. PNS has been shown to be effective for the treatment of chronic low back pain and is believed to have a positive impact on the processes of peripheral and central sensitization, which play a major role in pain chronification. Be sure to check out last week's episode on pain chronification for a deeper dive into this important topic (https://anchor.fm/spine/episodes/Back-to-basics-the-Chronification-of-Pain-eon8fq) and our interview with Dr. Ricardo Vallejo discussing the important interaction of glial cells in this process (https://anchor.fm/spine/episodes/More-glial-cells---Dr--Ricardo-Vallejo--science-that-matters--and-thinking-beyond-the-neuron-eb4m4i) PNS is an exciting treatment option for patients with chronic axial low back pain, including patients who continue to have symptoms despite radiofrequency ablation treatment. In this episode the doctors discuss an article published by Dr. Deer and his colleagues demonstrating that PNS, utilized for 6-12 hours per day for 60 days, resulted in significant improvement in pain and function in a group of patients with recurrent axial low back pain after radiofrequency ablation. Listen as the doctors discuss the specifics of PNS as a treatment option for chronic axial low back pain, including theories about its mechanism of action. Follow our practice on Facebook at Spine & Nerve Diagnostic Center. Please leave us a comment or review- these help us to improve and provide value to more people. This podcast is for information and educational purposes only, it is not meant to be medical advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve. References: 1) Deer et al. Percutaneous PNS of the Medial Branch Nerves for the Treatment of Chronic Axial Back Pain in Patients following Radiofrequency Ablation. Poster abstract. NANS 2021. 2) Tiffany Lin, MD, Akshat Gargya, MD, Harmandeep Singh, MD, Eellan Sivanesan, MD, Amitabh Gulati, MD, Mechanism of Peripheral Nerve Stimulation in Chronic Pain, Pain Medicine, Volume 21, Issue Supplement_1, August 2020, Pages S6–S12. 3) Vallejo R, Kelley CA, Gupta A, Smith WJ, Vallejo A, Cedeño DL. Modulation of neuroglial interactions using differential target multiplexed spinal cord stimulation in an animal model of neuropathic pain. Mol Pain. 2020 Jan-Dec;16:1744806920918057. 4) Moore et al. Spinal cord stimulation. BJA Education, 16 (8): 258–263 (2016).