​Algotec's NeuroStimulator PENS therapy® System is used to electrically stimulate peripheral nerves for the symptomatic relief and management of chronic neuropathic pain. ​​​​​​​

Indications include;
 

  • ​Occipital Neuralgia
  • ​Cluster Headache
  • ​Supra-orbital Neuralgia
  • ​Peripheral Neuralgia
  • ​Trigeminal Neuralgia
  • ​Intractable Facial Pain
  • ​Post Hernia Repair Pain
  • Neuropathic Chest Wall Pain
  • Stump Pain
  • Post Mastectomy Pain​

Jon H. Raphael, MD, Randomized Double-Blind Sham-Controlled Crossover Study of Short-Term Effect of Percutaneous Electrical Nerve Stimulation in Neuropathic Painpme_1215 1515..1522​​
31 patients with chronic pain with surface hyperalgesia. Pain diagnoses; surgical scar pain N = 7, occipital neuralgia N = 4, posttraumatic neuropathic pain N = 3, stump pain N = 2, inflammatory neuropathic pain N = 3, chronic low back pain N = 5, complex regional pain syndrome N = 1, pain following total knee replacement surgery N = 3, chronic cervical pain N = 1, and post-herpetic neuralgia N = 2.

The duration of time they had suffered from pain before having PENS therapy ranged from 1 to 35 years, with a mean of 8.1 years (SD  8.3 years). During this period, they had received a number of other therapies and medication that were either ineffective or of limited efficacy.
There were both clinically and statistically significant improvements in the NRS for pain and PPT after active therapy compared with sham. For the active treatments, 23 out of the 30 patients responded to therapy. The majority of patients treated with sham showed no improvement. One patient reported improvement following the sham therapy; however, this was not accompanied by a parallel change in the PPT.
Downlaod Raphael Paper (PDF)
Marco Rossi, Prof, A Novel Mini-invasive Approach to the Treatment of Neuropathic Pain: The PENS Study. 
Pain Physician 2016; 19:E121-E128 • ISSN 2150-1149
A Multicenter, prospective, observational study by four Italian pain therapy centers, to evaluate the short- and long-term efficacy of a single probe and single shot PENS approach.

Methods: Inclusion criteria were age ≥ 18 and ≤ 80 years, presence of severe peripheral neuropathic pain lasting more than 3 months, localized and refractory to pharmacological therapies.

Patients: Seventy-six patients (47 women, 29 men), mean age 62 ± 14 years, affected by neuralgia (21 herpes zoster infection, 31 causalgia, 24 postoperative pain)

Measurement: Numerical Rating Scale (NRS) and Neuropathic Pain Scale (NPS) were assessed at baseline, 60 minutes after PENS, at one week, after one, 3, and 6 months; perceived health outcome was measured with Euroqol-5 dimension (EQ-5D) questionnaire at baseline and at 6 months. 

Results: NRS and NPS decreased significantly after 60 minutes and the reduction remained constant over time at follow-up. EQ-5D increased significantly with respect to the baseline.

Limitations: Small sample size and non-randomized observational study; high prevalence of post-herpetic and occipital neuralgias.

Conclusion: PENS therapy produced significant and long-lasting pain relief in chronic peripheral neuropathic pains of different etiology. The present study confirms the feasibility, safety, and repeatability of this minimally invasive technique.
Pain intensity measured with NRS, showed a significant reduction at T1 (3 [IQ 7 – 10] vs 8 [IQ 7 – 10] at T0, P < 0.001), which remained constant over time (3 [IQ 0 – 6] at T5), without significant differences from T1 to T5 (Fig. 1). Fourteen patients (18.4%) referred NRS 0 – 1 at T1: 6 great occipital nerve, 5 trigeminal her​​​​​​pes zoster, 2 ilioinguinal nerve, one thoracic nerve.

The NPS data behaved in the same way, decreasing significantly at T2 in comparison with the basal value (2.9 [IQ 1.5 – 4.1] vs 6.4 [IQ 4.7 – 8.2] at T0, P < 0.001) and maintaining this reduction over time (2.1 [IQ 0.8 – 4.1] at T5) (Fig. 2).

EQ-5D increased significantly at T5 compared to the baseline (0.76 [IQ 0.55 – 1.00] vs 0.30 [IQ 0.02 – 0.62] at T0, P < 0.001), specifically for the dimensions pain/discomfort, anxiety/ depression, and mobility (Fig. 3). No differences in pain relief were detected between the trigger point subgroup and allodynic area subgroup.
Downlaod Rossi Paper (PDF)
Mark W. Weatherall et al, Percutaneous electrical nerve stimulation (PENS) therapy for refractory primary
headache disorders: a pilot study. 
BRITISH JOURNAL OF NEUROSURGERY

Purpose: Primary headache disorders are common, but many patients are refractory to medical treatment.

Percutaneous electrical nerve stimulation (PENS) therapy involves the stimulation of one or more individual nerves or dermatomes using needle probes. We assessed whether a ‘single shot with single probe’ strategy would benefit patients with refractory headache disorders, including chronic migraine (CM), and chronic cluster headache (CCH).

36 patients treated with PENS therapy between September 2012 and June 2016. Follow-up data were available for 33 patients, of whom 16 had CM, nine had CCH, and six had secondary headache disorders.

PENS was given using Algotec's disposable 21 gauge PENS therapy probes (8cm) to the occipital nerve ipsilateral to the pain (or bilaterally in cases of bilateral pain).

Results: Six of nine patients with CCH improved significantly after the first session. In all patients with CCH, PENS therapy was well tolerated, with no significant adverse events reported. One patient with CCH reverted to episodic cluster. Only four patients with CM experienced any benefit.
All the patients had previously failed to respond to between one and eight oral preventive medications (typically at least four), and had at best experienced temporary benefit from greater occipital nerve (GON) blocks with local anaesthetic and steroids. In reviewing the outcomes following PENS therapy, the patients with NPDH have been assessed alongside those with CM, as both patients had clear migrainous features during exacerbations of their persistent headache disorder.
Six out of the nine patients with CCH improved significantly after the first session, with reduced frequency and/or severity of attacks lasting at least 4 weeks (Table 2). Following further treatment four of these patients derived similar benefits on second and subsequent occasions, one patient experienced only transient benefit, and one patient declined further treatment. One additional patient, who had experienced only a transient benefit at first, did much better on subsequent occasions. In all patients with CCH, PENS therapy was well tolerated, with no significant adverse events reported. One patient with CCH reverted to the episodic form of the disorder; this improvement was maintained for more than two years following the cessation of therapy. By way of contrast, only four of the patients with CM/NDPH experienced any noticeable benefit with PENS therapy; one patient with CM/NDPH experienced pain during stimulation, two patients with CM/NDPH experienced severe neck pain, and three patients with CM/NDPH experienced an exacerbation of their condition lasting days to weeks.
Previous response to GON blockade does not seem to have been predictive of response to PENS in patients with CM: of the six CCH patients who benefited from PENS, two had previously experienced prolonged benefit from GON blocks (3–5 weeks, although one patient had become intolerant of the injections), three had derived only transient benefit (3–4 days), and one had not found GON blockade helpful; of the three CM patients who improved with PENS, one had previously had a prolonged response to GON blockade (2 months), one a transient response (4 days only), and one no response at all.
Downlaod Wheatherall Paper (PDF)
"This is definitely the best and most positive pain treatment I have ever had and I sincerely hope many other people will benefit from this wonderful painless treatment"
- Tina Hobin
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Patient Resources
 
Rewire Your Pain:
An easy to read book for people with persistent pain, about rewiring your pain to win back your life

Action On Pain:
National charity that offers support to people affected by chronic pain either as a sufferer or carer / relative 
www.action-on-pain.co.uk
 
British Pain Society:
Representative organization for pain professionals with information on various pain associated conditions 
www.britishpainsociety.org
 
COPING:
Derbyshire patient support group to help improve quality of living with pain 
www.coping.org.uk
 
Pain Relief Foundation:
Offers information services to chronic pain patients 
www.painrelieffoundation.org.uk
 
PainSupport:
Contact other patients for mutual support or information 
www.painsupport.co.uk
 
Pain Association Scotland:
Offers patient support information in local community 
www.chronicpaininfo.org

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Australian Pain Management Association:
Patient support groups in Australia
    

RELATED LINKS

Clinical Evidence
​NeuroStimulator PENS therapy®
What is PENS therapy ?