Plasticity-Inducing Percutaneous Peripheral Nerve Stimulation for Treating Neck Pain: A Blinded, Randomised Clinical...

Percutaneous peripheral nerve stimulation (pPNS) protocols that induce synaptic plasticity in animals were recently shown to produce hypoalgesia in humans. However, whether they can relieve pain in a clinical population remains unexplored. Here we investigated the effects of these pPNS protocols in pain symptoms of participants suffering from non-specific neck pain.

45 participants were divided into three groups: percutaneous Sensory-Threshold burst High-Frequency Stimulation (ST-bHFS), percutaneous Motor-Threshold Theta-Burst Stimulation (MT-TBS) or an active control group receiving 80 Hz TENS. A verbal numerical rating scale (VRNS) was used to assess spontaneous and movement-induced pain. Pain was also evaluated during the week before and the week after treatment, along with maximal strength and electromyography of the upper trapezius.

ST-bHFS produced a clinically relevant and significant reduction in spontaneous pain (1.8 ± 1.6 VRNS, p < 0.001), not detected in MT-TBS (0.8 ± 1.9, p = 0.105) or TENS (0.5 ± 1.3, p = 0.185). All protocols reduced movement-induced pain (MT-TBS 1.9 ± 1.6, p < 0.001; ST-bHFS 1.7 ± 2.2, p = 0.009; TENS 1.4 ± 1.5, p = 0.002), although the reduction in the TENS group did not reach clinical relevance. One week post-treatment, a clinically relevant and significant pain reduction was still present in the pPNS groups (MT-TBS 2.0 ± 1.3, p < 0.001; ST-bHFS 1.7 ± 2.6, p = 0.041), but not in the TENS group (0.7 ± 1.9, p = 0.350). Maximal strength increased significantly in TENS (3.5 ± 5.1 kg, p = 0.019) and MT-TBS groups (2.8 ± 4.2, p = 0.021), without electromyographic changes.

pPNS protocols reduced pain symptomatology in patients with non-specific neck pain. Contrary to TENS, ST-bHFS reduced spontaneous pain and pain reduction lasted for a week in both pPNS groups. These results hold promise for improving the use of pPNS through translation of fundamental pain neuroscience.

Plasticity-inducing protocols applied through percutaneous peripheral nerve stimulation are an effective non-pharmacological treatment. They represent a clinically relevant option for pain management that could influence clinical practice as well as future fundamental and clinical research.

ClinicalTrials.gov identifier: NCT06153875.