The Dudley Group of Hospitals NHS Foundation Trusts Pain Service introduced Percutaneous Electrical Nerve Stimulation (PENS) as an additional management Option in 2007, and it has since developed as a predominately Nurse led service.
Percutaneous Electrical Nerve Stimulation (PENS) is a relatively new electro analgesic therapy. It is similar in practical concept to transcutaneous electrical nerve stimulation (TENS) but differs in that 21gauge needle-like probes are inserted percutaneously into an area of tissue, and then electrical current is passed through the probe to stimulate the nerves.
Clinically, PENS may be preferable to TENS. It can be used in areas of allodynic neuropathic pain which cannot tolerate TENS application directly onto the skin. Since it also bypasses the resistance of the cutaneous barrier and delivers the electrical stimulus in closer proximity to the nerve endings, it may be more effective. Compared with implantable peripheral nerve stimulation, the PENS technique is less invasive, less costly, and less risk-ridden. PENS is also a very useful non-pharmacological alternative to opiate and non-opiate analgesic medications.
It involves the percutaneous insertion of a disposable probe in order to stimulate peripheral sensory nerves that supply a specific area of Neuropathic pain described by a patient. The probe is normally placed into the fatty layer directly beneath the area of pain identified by the patient.
PENS is a totally reversible, non-destructive and relatively painless procedure. PENS has the potential for differing uses within a multi-faceted pain service, the advantages are, it is a day treatment procedure with the patient only requiring a bed for the duration of the treatment with a short recovery period following the completion of the treatment. It is a procedure that is suited to being developed as a Nurse led initiative within the pain service.
Training needs are minimal. Within our particular pain service in the United Kingdom, income generation potential is good.
PENS clinics are now held on a monthly basis at The Dudley Group of Hospitals NHS Foundation Trust with a minimum of 8 patients per clinic. Each patient attends for 4 sessions with extensive evaluation between each session. At the end of the 4 sessions there is a multi professional team discussion, involving both patient and Algotec technical support staff, to determine future management.
Through the development of this as a Nurse led service the quality of the patients experience and that of the Nurse specialist has been greatly enhanced as they have had continuity of care for the patient and a high level of job satisfaction for the Nurse Specialist.
The presence and input of the Clinical Nurse Specialist and Algotec staff throughout the whole process ensures that at every step of the patient’s journey the key people involved had a comprehensive understanding of the patient’s pain presentation as well as the other factors that had influenced and impacted on their lifestyle due to the pain. It is felt by all involved in these cases, including the patient and Algotec technical support staff, that having continuity of care at every stage of the treatment pathway is a big contributor to a successful outcome.
PENS is not a suitable treatment option for every patient who presents with Neuropathic pain, but for those who meet our selection criteria it offers another avenue to explore.
PENS can be an excellent therapy for the experienced Pain Nurse Specialist to develop; it offers opportunity to expand clinical skills and knowledge as well as enhancing job satisfaction as you can achieve completion of a patient’s treatment.
Jane Southall RGN, BSc (Hons)
Post grad Diploma in Business Management, ENB 923,988. ENB Higher award.
Lead Clinical Nurse Specialist, Chronic Pain
Dudley Group of Hospitals NHS Foundation Trust.
