• Jijun Xu, Zhuo Sun, Jiang Wu, Maunak Rana, Joshua Garza, Alyssa C Zhu, Krishnan V Chakravarthy, Alaa Abd-Elsayed, Ellen Rosenquist, Hersimren Basi, Paul Christo, and Jianguo Cheng.
• Department of Pain Management, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH; Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH; Department of Anesthesiology, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH.
• Pain Physician. 2021 Mar 1; 24 (2): E131-E152.

BackgroundPeripheral nerve stimulation (PNS) has been increasingly used to manage acute and chronic pain. However, the level of clinical evidence to support its use is not clear.ObjectivesTo assess the clinical evidence of PNS in the treatment of acute or chronic pain.Study DesignA systematic review of the efficacy and safety of PNS in managing acute or chronic pain.MethodsData sources were PubMed, Cochrane Library, Scopus, CINAHL Plus, Google Scholar, and reference lists. The literature search was performed up to December 2019. Study selection included randomized trials, observational studies, and case reports of PNS in acute or chronic pain. Data extraction and methodological quality assessment were performed utilizing Cochrane review methodologic quality assessment and Interventional Pain Management Techniques-Quality Appraisal of Reliability and Risk of Bias Assessment (IPM-QRB) and Interventional Pain Management Techniques-Quality Appraisal of Reliability and Risk of Bias Assessment for Nonrandomized Studies (IPM-QRBNR). The evidence was summarized utilizing principles of best evidence synthesis on a scale of 1 to 5. Data syntheses: 227 studies met inclusion criteria and were included in qualitative synthesis.ResultsEvidence synthesis based on randomized controlled trials (RCTs) and observational studies showed Level I and II evidence of PNS in chronic migraine headache; Level II evidence in cluster headache, postamputation pain, chronic pelvic pain, chronic low back and lower extremity pain; and Level IV evidence in peripheral neuropathic pain, and postsurgical pain. Peripheral field stimulation has Level II evidence in chronic low back pain, and Level IV evidence in cranial pain.LimitationsLack of high-quality RCTs. Meta-analysis was not possible due to wide variations in experimental design, research protocol, and heterogeneity of study population.ConclusionsThe findings of this systematic review suggest that PNS may be effective in managing chronic headaches, postamputation pain, chronic pelvic pain, and chronic low back and lower extremity pain, with variable levels of evidence in favor of this technique.

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