Using Peripheral Nerve Stimulation to Treat Neuropathies of the Upper Extremity: A Systematic Review

Peripheral neuropathy of the upper extremity often arises from nerve entrapment or nerve injury and can result in chronic, debilitating pain. Peripheral nerve stimulation (PNS) has been shown to restore nerve function and provide pain relief in various neuropathies, particularly in cases refractory to conventional pain management strategies. Our aim was to evaluate the effectiveness of PNS for alleviating peripheral neuropathy-related neuropathic pain resulting from upper extremity nerve entrapment or injury.

A systematic search was conducted across PubMed, Cochrane, Ovid Medline, and Web of Science to identify studies using PNS in upper extremity nerve entrapment or injury patients with reported outcomes measuring neuropathy (pain, sensory and motor function). Data regarding PNS type, neuropathy type, pain scores, motor unit number estimation, treatment duration, and study quality were extracted.

Twenty-six studies (973 total participants) were included. Twenty-two studies reported pain relief, with significant decreases in the 11-point Numeric Pain Rating Scale from baseline (effect size: 2.92-6.43). Four studies reported improved nerve function. All studies evaluating secondary outcomes such as concomitant pain medication use and quality of life found improvement in at least one measure. Both permanent and temporary PNS yielded significant improvements, with minimal complications and promising long-term outcomes.

Overall, PNS may be a safe and effective nonpharmacologic method to treat pain related to neuropathy as well as improve function and quality of life in patients with nerve entrapment or injury of the upper extremity. More controlled studies are needed to assess the effectiveness of PNS compared to usual care.