439 Percutaneous Electrical Nerve Stimulator for Treatment of Chronic Spinal Pain

Abstract

INTRODUCTION: The percutaneous electrical nerve stimulator (PENS) is a relatively new device for the treatment of chronic spinal pain. This programmable device is worn for a recommended 10 to 12 days on the external ear, stimulating the auricular vagus nerve. It is postulated to release endorphins and relieve pain. There is minimal literature on the use of PENS as an adjunct to pain management in patients with chronic spinal pain. METHODS: Patients who had the PENS placed for chronic refractory spinal pain were included in the study. All patients failed multiple forms of treatment such as physical therapy, epidural steroid injections, and medication. RESULTS: In 2021, 114 patients had the PENS placed. The mean patient follow-up was 34.9 weeks. 67 patients (58.7%) felt pain relief due to the PENS. In patients with neck pain, the mean Neck Disability Index scores decreased from 43.8% to 25.4%, and the mean Numerical Rating Scores (NRS) decreased from 7.9 to 3.9. In patients with low back pain, the mean Oswestry Disability Index scores decreased from 47.6% to 33.5%, and the mean NRS scores decreased from 7.9 to 5.1. The rate of improvement in patients with neck pain (71.9%) was significantly greater (p-value <0.02) than in patients with back pain (56.4%). Interestingly, 33.3% of patients who responded to treatment remained improved at one year follow-up. CONCLUSIONS: Our study shows that a significant number of patients experienced reduced pain and disability as a result of treatment with the PENS. Patients with neck pain responded better than patients with low back pain. Many patients in this difficult patient population experienced durable relief, lasting over one year. Our study suggests that the PENS may be a useful adjunct in the management of patients with chronic spinal pain.