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      Mechanism of Peripheral Nerve Stimulation in Chronic Pain

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          Abstract

          Introduction

          With the advancement of technology, peripheral nerve stimulation (PNS) has been increasingly used to treat various chronic pain conditions. Its origin is based on the gate control theory postulated by Wall and Melzack in 1965. However, the exact mechanism behind PNS’ analgesic effect is largely unknown. In this article, we performed a comprehensive literature review to overview the PNS mechanism of action.

          Design

          A comprehensive literature review on the mechanism of PNS in chronic pain.

          Methods

          Comprehensive review of the available literature on the mechanism of PNS in chronic pain. Data were derived from database searches of PubMed, Scopus, and the Cochrane Library and manual searches of bibliographies and known primary or review articles.

          Results

          Animal, human, and imaging studies have demonstrated the peripheral and central analgesic mechanisms of PNS by modulating the inflammatory pathways, the autonomic nervous system, the endogenous pain inhibition pathways, and involvement of the cortical and subcortical areas.

          Conclusions

          Peripheral nerve stimulation exhibits its neuromodulatory effect both peripherally and centrally. Further understanding of the mechanism of PNS can help guide stimulation approaches and parameters to optimize the use of PNS.

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          A review of vagus nerve stimulation as a therapeutic intervention

          Rhaya Johnson, Christopher G Wilson (2018)
          In this review, we provide an overview of the US Food and Drug Administration (FDA)-approved clinical uses of vagus nerve stimulation (VNS) as well as information about the ongoing studies and preclinical research to expand the use of VNS to additional applications. VNS is currently FDA approved for therapeutic use in patients aged >12 years with drug-resistant epilepsy and depression. Recent studies of VNS in in vivo systems have shown that it has anti-inflammatory properties which has led to more preclinical research aimed at expanding VNS treatment across a wider range of inflammatory disorders. Although the signaling pathway and mechanism by which VNS affects inflammation remain unknown, VNS has shown promising results in treating chronic inflammatory disorders such as sepsis, lung injury, rheumatoid arthritis (RA), and diabetes. It is also being used to control pain in fibromyalgia and migraines. This new preclinical research shows that VNS bears the promise of being applied to a wider range of therapeutic applications.
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            Pain mechanisms: a new theory.

            R Melzack, P D Wall (1965)
            Article 0 comments Cited 136 times – based on 0 reviews     Review now
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              Adenosine A1 receptors mediate local anti-nociceptive effects of acupuncture.

              Kim Tieu, Maiken Nedergaard, Takumi Fujita … (2010)
              Acupuncture is an invasive procedure commonly used to relieve pain. Acupuncture is practiced worldwide, despite difficulties in reconciling its principles with evidence-based medicine. We found that adenosine, a neuromodulator with anti-nociceptive properties, was released during acupuncture in mice and that its anti-nociceptive actions required adenosine A1 receptor expression. Direct injection of an adenosine A1 receptor agonist replicated the analgesic effect of acupuncture. Inhibition of enzymes involved in adenosine degradation potentiated the acupuncture-elicited increase in adenosine, as well as its anti-nociceptive effect. These observations indicate that adenosine mediates the effects of acupuncture and that interfering with adenosine metabolism may prolong the clinical benefit of acupuncture.
              Article 0 comments Cited 108 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Pain Med
                Journal ID (iso-abbrev): Pain Med
                Journal ID (publisher-id): painmedicine
                Title: Pain Medicine: The Official Journal of the American Academy of Pain Medicine
                Publisher: Oxford University Press
                ISSN (Print): 1526-2375
                ISSN (Electronic): 1526-4637
                Publication date Collection: August 2020
                Publication date (Electronic): 11 August 2020
                Publication date PMC-release: 11 August 2020
                Volume: 21
                Issue: Suppl 1 , Peripheral Nerve Stimulation: Update for the 21st Century
                Pages: S6-S12
                Affiliations
                [1 ] Department of Anesthesiology, NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York
                [2 ] Department of Anesthesiology, Johns Hopkins School of Medicine, Baltimore, Maryland
                [3 ] Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center , New York, USA
                Author notes
                Correspondence to: Amitabh Gulati, MD, Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, 1275 York Ave M-308, New York, NY 10065, USA. Tel: 212-639-6851; Fax: 212-717-3206; E-mail: gulatia@ 123456mskcc.org .
                Author information
                http://orcid.org/0000-0003-3419-9209
                Article
                Publisher ID: pnaa164
                DOI: 10.1093/pm/pnaa164
                PMC ID: 7828608
                PubMed ID: 32804230
                SO-VID: 8cc000b6-67a9-4640-ac6c-28f57991d7bd
                Copyright © © The Author(s) 2020. Published by Oxford University Press on behalf of the American Academy of Pain Medicine.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence ( http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                Page count
                Pages: 7
                Funding
                Funded by: National Cancer Institute Cancer Center Support;
                Award ID: P30CA008748
                Funded by: NIH, DOI 10.13039/100000002;
                Categories
                Subject: EDITORIAL
                Subject: Review Articles
                Subject: AcademicSubjects/MED00010

                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: peripheral nerve stimulation,chronic pain,mechanism
                Data availability:
                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: peripheral nerve stimulation, chronic pain, mechanism

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