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"Introduction:
Post-operative scar pain of neuropathic origin is not an uncommon occurrence and it is usually around the area of the scar. We are reporting a case of neuropathic pain distal to the actual surgical scar site, which was successfully treated with PENS. Percutaneous Electrical Nerve Stimulation (PENS) is such a therapy that is technically suited to treat localized areas of hyperalgesia and allodynia because the surface skin is not directly touched during stimulation. With PENS, unlike TENS, the stimulating probes are percutaneously introduced and advanced subcutaneously, in order to stimulate peripheral nerve fibres that supply the specific area of neuropathic pain. The probe is normally placed into the fatty layer directly beneath the area ofpain identified by the patient, thus being in close proximity to the affected nerve endings.
Conclusion:
PENS is a new analgesic therapy that combines the advantages o both electro-acupuncture and transcutaneous electrical nerve stimulation (TENS). PENS is preferable to TENS in that it bypasses the resistance of the cutaneous barrier and delivers the electrical stimulus within closer proximity to the nerve endings located in the affected area. Compared to implantable peripheral nerve stimulation, PENS is minimally invasive, considerably cheaper and carries minimal risk. PENS is also a very useful non-pharmacological adjuvant to neuropathic pain medications and opioids thus avoiding the problem of tolerance and physical dependence that is associated with long-term opioid use. The excessive sedation and gastrointestinal side effects that are often experienced with conventional analgesics are also avoided with PENS therapy (Ahmed, Craig, White, & Huber). PENS is totally reversible, nondestructive and is tolerated well by patients as an outpatient procedure. It can be used in areas of allodynia where the patient cannot tolerate TENS application directly onto the skin.Further studies are needed in multiple patients to see the effect of proximal stimulation using PENS to treat the pain at a distal site." |
NeuPSIG
