Percutaneous peripheral nerve stimulation for shoulder pain: A systematic review of randomized controlled trials

Shoulder pain is highly prevalent and may persist despite conservative care, leading to functional limitation and substantial healthcare burden. Percutaneous peripheral nerve stimulation (PNS) has emerged as a targeted neuromodulation strategy; however, randomized evidence remains heterogeneous across stimulation parameters and clinical presentations. This systematic review followed PRISMA 2020 guidelines and was registered in PROSPERO (CRD420251247712). PubMed, Scopus, Embase, and Web of Science were searched (December 2015-December 2025; English language). Randomized controlled trials (RCTs) evaluating percutaneous PNS-related interventions for postoperative shoulder pain, chronic shoulder pain, supraspinatus tendinopathy, upper trapezius myofascial pain, and cervical-related shoulder pain were included. The search identified 2189 records; after removal of 723 duplicates, 1466 titles and abstracts were screened and 54 full texts assessed. Ten RCTs met eligibility criteria. Postoperative trials demonstrated clinically meaningful pain reductions and opioid-sparing effects with ultrasound-guided brachial plexus PNS compared with sham stimulation. In supraspinatus tendinopathy, multimodal programs integrating PNS with eccentric exercise and percutaneous electrolysis yielded superior improvements in pain and disability compared with conventional rehabilitation. For upper trapezius myofascial pain, intramuscular and percutaneous stimulation protocols produced short-term improvements in pain and mechanical sensitivity. Cervical neuromuscular stimulation trials also demonstrated significant benefits in pain and range of motion. Overall risk of bias was moderate to high, with the majority of trials rated as low risk and the remainder as having some concerns. Current RCT evidence supports percutaneous PNS as a safe and clinically relevant intervention for shoulder pain, particularly in postoperative analgesia and chronic tendinopathy when integrated into rehabilitation programs. However, substantial variability in stimulation dosimetry highlights the need for protocol standardization in future trials.