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Percutaneous Electrical Nerve Stimulation (PENS) or
Percutaneous Neuromodulation Therapy (PNT)

PENS is a minimally invasive electrical stimulation treatment for chronic pain. This works by helping to change the way pain nerves relay their pain message. No medication is injected. The needles used are extremely thin, like acupuncture needles. Up to 10 needles (5 electrical channels) are used. Small wires from a battery-powered electrical stimulator are used to deliver non-painful electrical stimulation near the nerves and in the tissues under the skin, such as the muscles.

Most patients feel a tolerable tapping or tingling sensation and do not find the treatment uncomfortable. A 20-30 minute treatment is given during the first session, and then further treatments are provided up to 10 times over several weeks. Many patients feel immediate improvement after the first or second treatment due to relaxation of muscle spasm, but it can take 4-5 treatments for the early benefit to be felt.

PNT/PENS is a type of neuromodulation. Neuromodulation is a category of treatment that is designed to alter the way the nervous system (nerves, spinal cord, and/or brain) transmits messages, such as the pain messages that occur when pain nerve cells are stimulated or damaged. Other types of neuromodulation include spinal cord stimulation for refractory pain, and transcranial magnetic stimulation, that is being tested for both depression and for chronic pain.

There are a few potential side effects to be considered with PENS, as with any medical treatment. There could be increased pain at the treatment locations. A bruise or bleeding could occur. Damage to a nerve or infection are possible but very unlikely. A collapsed lung could very rarely occur with treatment in the lower neck or in the chest area. You should not receive this treatment if you have a pacemaker or defibrillator.

PENS/PNT is different from TENS (transcutaneous electrical nerve stimulation) or electrical muscles stimulation on the skin that you may have experienced during physical therapy. There is a very high electrical impedance (resistance or blockage) of the skin which is overcome by the medical procedure of PENS/PNT.

Many patients are able to increase their activity and perform stretching exercises, which in turn reduces such secondary complications of chronic pain such as muscle spasm. In cases such as this, the benefits of PENS may prevent the recurrence of the pain-spasm-inactivity cycle which plagues so many patients.

The results of the treatments may last for a long time, but in some cases can be temporary. If needed, further treatments can be given on an as needed basis. As no medication is injected, there are no set limits as to the number of treatments that can be given. The pain relief provided by the treatment may allow you to reduce the amount of pain medication you are taking, but medication can still be used if necessary during the course of treatment.

PENS for Painful neuropathy:

 An Evidence-Based Guideline on Treatment of Painful Diabetic Neuropathy from the American Association of Neuromuscular and Electrodiagnostic Medicine, the American Academy Of Neurology, and the American Academy of Physical Medicine & Rehabilitation concluded:

  “Recommendations:  Percutaneous electrical nerve stimulation should be considered for the treatment of PDN (Level B).”


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