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Published on: January 29, 2014
Repeat round of auricular percutaneous electrical nerve field stimulation for pediatric disorders of gut brain
Lev Dorfman1,2,3, Khalil El-Chammas1,4, Kahleb Graham1,4
1Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Objectives:
Percutaneous electrical nerve field stimulation (PENFS) is an FDA-approved nonpharmacological modality for treating disorders of gut-brain interaction (DGBI) in pediatric patients. PENFS presumably functions through stimulation of cranial nerves. There is limited data on patients that require more than a 4-week cycle of treatment with PENFS. We examined the effect of repeated rounds of PENFS on recurrent symptoms and predictors for multiple treatments.
Methods:
We evaluated charts of patients who underwent PENFS placement for DGBI. Data included demographics, medical history, and validated questionnaire responses. Changes over time after each round of placement were assessed. Baseline measures were compared between patients with single versus two rounds.
Results:
A total of 22 patients (median age 17.5 years, 18 (82%) females) with repeated PENFS met the inclusion criteria. A propensity-matched control group (n = 22) showed no significant differences in demographics or diagnoses. Patients requiring repeated PENFS placements had higher PCS-C scores (median 24.5 (IQR 18-28) vs. 16.5 (IQR 9.5-22.5); p = 0.0135), and higher PHQ-9 scores (median 10 (IQR 8-14) vs. 7 (IQR 7.5-9.5); p = 0.0272). The second round of PENFS placements significantly reduced API, PCS-C, FDI, PHQ-9, and CSI scores (p < 0.05). No statistically significant differences between scores after the first and second rounds were noted.
Conclusion:
Repeating PENFS treatments are becoming common in clinical practice. Our study shows that repeat rounds are as effective as the initial ones, with pain catastrophizing and depression predicting worse outcomes and the need for repeat and/or longer round of treatment.
