Valerie Rome, BA
Third Year Medical Student
Rowan-Virtua SOM
Voorhees, New Jersey, United States
Seth J. Spicer, MS
Medical Student
Futures Forward Research Institute
Voorhees, New Jersey, United States
Shikhar Manchanda, BS
Medical Student
Rowan-Virtua SOM
Stratford, New Jersey, United States
Kunal P. Shah, MS
Medical Student
Rowan-Virtua SOM
Stratford, New Jersey, United States
Behnum Habibi, MD (he/him/his)
Assistant Program Director, Physical Medicine & Rehabilitation
Lewis Katz School of Medicine at Temple University
Philadelphia, Pennsylvania, United States
Mononeuropathy is a condition in which damage is done to a single nerve outside of the central nervous system resulting in weakness, loss of sensation, or burning sensations in that nerve. Common examples of mononeuropathy include Carpal Tunnel Syndrome, Meralgia Paresthetica, and Ulnar Neuropathic Pain. Conservative treatments such as steroid injections, medications such as Gabapentin, and physical therapy are used to treat most mononeuropathies, however, in cases where the mononeuropathies are resistant to conservative treatment, alternative treatment modalities such as peripheral nerve stimulation (PNS) are required.
Design:
A systematic review and pooled analysis of pain scores before and after PNS for mononeuropathy that failed conservative treatment was performed following PRISMA 2020 Guidelines. Pain outcomes were reported and analyzed using the Visual Analogue Scale (VAS) or Numeric Rating Scale (NRS). A boolean string was utilized to search 5 major databases which resulted in 194 studies that were exported to rayyan.ai. 24 duplicates were deleted leaving 170 articles for inclusion exclusion screening. Of those 8 studies underwent full-text review.
Results:
3 studies met inclusion criteria consisting of n = 23 participants. The weighted average pain scores at baseline were 8.01 ± 0.93 and, at an average follow-up time of 5.51 months, was 2.97 ± 1.23 representing a statistically significant (p < 0.001) decrease with an effect size of Cohen’s D = 4.68.
Conclusions:
The minimum clinically important difference (MCID) for VAS pain relief is a decrease of 1.37. The weighted mean decrease of 5.22 points represents a very large clinically relevant decrease in pain. Peripheral nerve stimulation is an effective therapy for mononeuropathy that failed conservative treatment strategies such as physical therapy and pharmacologic treatments. Future research studies are required to confirm these results and to determine the length of pain relief with PNS.
