The Predictive Value of Transcutaneous Electrical Nerve Stimulation for Patient Selection in Peripheral Nerve Field Stimulation for Chronic Low Back Pain: A Prospective Study

Frank Patrick Schwarm; Marc Ott; Jasmin Nagl; Michael Bender; Marco Stein; Eberhard Uhl; Hagen Maxeiner; Malgorzata A Kolodziej

doi:10.1111/ner.13244

The Predictive Value of Transcutaneous Electrical Nerve Stimulation for Patient Selection in Peripheral Nerve Field Stimulation for Chronic Low Back Pain: A Prospective Study

Neuromodulation. 2021 Aug;24(6):1051-1058. doi: 10.1111/ner.13244. Epub 2020 Aug 5.

Authors

Frank Patrick Schwarm¹, Marc Ott¹, Jasmin Nagl¹, Michael Bender¹, Marco Stein¹, Eberhard Uhl¹, Hagen Maxeiner², Malgorzata A Kolodziej¹

Affiliations

¹ Department of Neurosurgery, Justus-Liebig-University Giessen, Giessen, Germany.
² Department of Anesthesiology, Intensive Care and Pain Therapy, Justus-Liebig-University Giessen, Giessen, Germany.

PMID: 32757257
DOI: 10.1111/ner.13244

Abstract

Objective: Peripheral nerve field stimulation (PNFS) is an effective alternative treatment for patients with chronic low back pain. Transcutaneous electrical nerve stimulation (TENS) is frequently used in pain therapy. Aim of this prospective study was to examine the predictive value of TENS for later PNFS treatment.

Materials and methods: Between 2014 and 2019, a prospective cohort study of 41 patients with chronic lumbar pain was conducted. Pain intensity (NRS) was assessed before and after TENS use, preoperatively/postoperatively and in the follow-up after three and six months, SF12v2 questionnaires with physical (PCS) and mental component summary (MCS) scores, and Oswestry disability index (ODI) questionnaire at baseline as well as three and six months after PNFS implantation. Implantation of the PNFS-system with two percutaneous leads was performed after four to seven days of positive testing. Statistical analysis was performed using depending t-test, ANOVA, and Spearman correlation.

Results: The cohort consisted of 41 patients (19 females, 22 males) with a median age of 60.5 years (IQR^25-75 52-67). Two patients were lost to follow-up. After positive PNFS testing a pulse generator (IPG) was implanted in 15 patients with positive TENS effect and 15 patients without TENS effect. Leads were explanted in nine patients after negative PNFS trial phase. TENS positive patients showed significant correlation to a positive effect in the PNFS trial phase in NRS reduction (p = 0.042) indicating that TENS responders will also respond to PNFS (94% patients). After three and six months follow-up median NRS and SF12v2 (PCS) improved significantly in both cohorts, SF12v2 (MCS) and ODI only in the TENS positive cohort, respectively.

Conclusion: TENS can be predictive for patient selection in PNFS, as TENS positive patients showed significant correlation with a positive PNFS trial period. Therefore, TENS positive patients might be justifiable to be directly implanted with leads and IPG. TENS positive patients further tend to show a better improvement in the follow-up.

Keywords: Chronic low back pain; PNFS; TENS; multimodal therapy; predictive value; trial phase.

MeSH terms

Adult
Aged
Female
Humans
Low Back Pain* / therapy
Male
Middle Aged
Patient Selection
Peripheral Nerves
Prospective Studies
Transcutaneous Electric Nerve Stimulation*
Treatment Outcome