What is Pens?
Percutaneous Electrical Nerve Stimulation (PENS) is a relatively modern neurostimulation therapy for the treatment of chronic neuropathic pain. PENS is similar to TENS (Transcutaneous Electrical Nerve Stimulation), a therapy in which a low voltage electrical current is delivered to the area of pain via electrodes. With TENS, the electrodes are placed onto the skin (transcutaneous), however, with PENS, the current is delivered into the subcutaneous (fatty) tissue close to the pain generating nerve via an “electro-acupuncture” type needle.
Unlike radiofrequency neurotomy/ablation therapies that deliver heat to damage pain generating nerves and interrupt pain signalling, the delivery of low voltage electrical current aims to desensitise the nerve to pain signals and hence provide pain relief. This is similar to peripheral nerve neuromodulation, without the need for invasive surgery/implants.
What do most patients experience?
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.
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PENS therapy is used to treat chronic nerve pain including areas of hypersensitivity, headache and chronic post-surgical pain. Occasionally PENS is used as a diagnostic tool.
The entire procedure will only take 10-15 minutes. The patient is fully awake and should not feel any discomfort. The patient will have electrodes placed in the ear according to the mapped pain points on the ear. If patients are experiencing low back pain then electrodes will be placed on the auricular points associated with the low back. If the patient is having knee pain then the electrodes will be placed on the auricular points associated with knees.
The patient will wear the electrodes and battery pack for 10 days. After 10 days the patient will return to the office to have the electrodes and battery pack removed. This 10-day charge is enough to sustain up to 6 months of charge.
Some patients will have total pain relief, others experience prolonged pain relief for 3 months or more and others get relief for shorter periods of time. Some may not get any benefit at all from the procedure.
PENS can be repeated at intervals if you and your doctor feel this is appropriate and effective for you.
There may be some local bruising and tenderness at the probe insertion site/s. There is a very small risk of infection and nerve damage.
- The patient can go home immediately after the PENS therapy and can drive
- They can resume their normal daily activities
- If the probe insertion site is sore take the patient will take regular painkillers as needed
- The patient will leave the dressing on for 10 days when they will return to the office to have the battery pack removed.