Percutaneous Electrical Nerve Stimulation (PENS)
Sciatica due to a herniated nucleus pulposus is a common cause of pain and constitutes an important socioeconomic problem in our society .
Its lifetime prevalence is estimated to be 40%. While analgesic medications can provide temporary pain relief, both opioid and non-opioid analgesics are associated with well-known side effects.
Although epidural steroid injections offer short-term improvement in the leg pain associated with a herniated disc, they do not offer significant functional benefits and do not reduce the need for surgery.
Introduction to PENS
Percutaneous Electrical Nerve Stimulation (PENS) is a minimally invasive procedure designed to relieve pain by stimulating the nerves that are causing discomfort. This therapy combines the beneficial aspects of both Transcutaneous Electrical Nerve Stimulation (TENS) and electroacupuncture, using acupuncture-like needles inserted into the soft tissue to target the peripheral sensory nerves at the dermatomal levels associated with the pathology.
How Does PENS Work?
In a typical PENS session, thin needles are inserted into the muscle or soft tissue near the affected nerve. These needles are connected to a low-voltage electrical generator that sends mild electrical impulses to stimulate the nerve. The stimulation interferes with the pain signals being sent to the brain, which helps to reduce the sensation of pain and improve functionality.
According to research, including a study by Ghoname et al., PENS has been shown to be more effective than TENS and exercise therapies in providing short-term pain relief and improving physical function in patients with long-term low back pain (LBP). The treatment has demonstrated particular success in reducing pain associated with conditions like sciatica that are related to degenerative disc disease.
Benefits of PENS for Sciatica
PENS therapy provides multiple advantages, especially for patients with sciatica, by:
Targeting the source of the pain: The placement of needles along the dermatomal level of the affected nerves ensures that the therapy directly addresses the source of irritation.
Non-pharmacologic: PENS offers a drug-free alternative for pain relief, which can be crucial for patients concerned about the side effects of long-term medication use.
Immediate and long-term relief: Studies have shown that PENS can provide immediate analgesic effects and, with repeated sessions, longer-lasting pain relief.
Improved physical function: By decreasing pain levels, PENS enables patients to engage in physical activities that they might otherwise avoid due to discomfort. This, in turn, can aid in rehabilitation efforts.
Comparing PENS with Other Treatments
Compared to TENS, which applies electrical stimulation through pads placed on the skin’s surface, PENS delivers electrical impulses directly into the muscle and nerve tissue, leading to a more targeted and effective treatment for certain conditions. The research has also indicated that patients receiving PENS therapy report better pain relief and enhanced quality of life compared to those receiving TENS or exercise therapy alone
PENS therapy’s ability to reduce the need for oral analgesics is another significant benefit, as demonstrated by the reduction in daily non-opioid analgesic intake by patients undergoing PENS therapy. This factor alone makes PENS an attractive option for individuals who wish to avoid the risks associated with long-term pain medication use.
What to Expect During a PENS Treatment
PENS treatments are typically short, lasting around 30 minutes per session. The procedure is generally well-tolerated, with many patients describing a mild tapping or tingling sensation during the electrical stimulation. Because the needles are thin and the electrical impulses are low in intensity, discomfort is minimal.
The number of sessions required varies depending on the severity of the condition and the individual’s response to treatment. In many cases, patients begin to notice improvements in pain levels and physical function after just a few sessions, although a full course of treatment may involve multiple weeks of therapy.
Is PENS Right for You?
PENS therapy is not suitable for everyone, but it is particularly effective for individuals with chronic low back pain, sciatica, or pain caused by degenerative disc disease. It is also an excellent option for patients who have not found relief through medications, physical therapy, or TENS treatments.
However, patients with certain medical conditions, such as those with pacemakers or bleeding disorders, should discuss the risks and benefits of PENS with their healthcare provider before proceeding with the treatment.
Final Thoughts
Sciatica can significantly impact your quality of life, but non-invasive treatments like PENS offer hope for relief without the risks of surgery or long-term medication use. By targeting the nerves responsible for pain and providing immediate and long-term benefits, PENS has proven to be a valuable tool in managing sciatica and chronic low back pain.
Do you have more questions?
What exactly is sciatica, and how is it different from regular back pain?
Sciatica refers to pain caused by irritation or compression of the sciatic nerve, which radiates down the back of the leg. Unlike regular back pain, which is localized, sciatica causes radiating pain along the nerve’s path, often accompanied by numbness, tingling, or weakness in the leg.
What is PENS therapy, and how does it help with sciatica?
Percutaneous Electrical Nerve Stimulation (PENS) involves inserting fine needles near the affected nerve to deliver low-voltage electrical impulses. It helps alleviate sciatica by blocking pain signals and promoting better nerve function.
How is PENS different from TENS therapy?
While TENS (Transcutaneous Electrical Nerve Stimulation) uses electrode pads on the skin to deliver electrical impulses, PENS inserts needles directly into the soft tissue near the nerve, providing more targeted relief for deeper nerve issues like sciatica.
Is PENS safe, and what are the side effects?
PENS is considered safe, with minimal risks. Side effects are rare but can include temporary soreness, bruising, or mild bleeding at the needle insertion sites.
How long does it take to see results from PENS therapy?
Many patients experience pain relief after just a few PENS sessions. However, optimal results often require multiple treatments over several weeks.
How many PENS sessions will I need?
The number of sessions varies based on the severity of your sciatica and how you respond to treatment. Most patients benefit from 6 to 10 sessions over a few weeks.
What other non-surgical treatments are available for sciatica?
Non-surgical treatments include physical therapy, anti-inflammatory medications, epidural steroid injections, and alternative therapies like acupuncture and chiropractic care.
When should I consider surgery for sciatica?
Surgery is typically considered when conservative treatments fail to relieve symptoms, or if you have severe pain, weakness, or loss of bladder or bowel control due to nerve compression.
What type of surgery is used to treat sciatica?
The most common surgical options include microdiscectomy, where part of a herniated disc is removed, and laminectomy, where a portion of the vertebrae is removed to relieve pressure on the nerve.
Can PENS therapy replace the need for surgery?
In many cases, PENS can delay or eliminate the need for surgery, especially for patients with chronic sciatica or those who prefer non-invasive treatments.
Is PENS therapy painful?
Most patients describe the sensation during PENS as a mild tapping or tingling. The needles used are very thin, and the electrical impulses are low in intensity, making the procedure generally well-tolerated.
How effective is PENS for long-term relief of sciatica?
PENS has been shown to provide significant short-term pain relief. Long-term outcomes are variable and may depend on the underlying cause of sciatica. Some patients report extended periods of pain relief after completing their PENS treatment course.
Can PENS be combined with other treatments?
Yes, PENS is often used alongside other therapies such as physical therapy, medications, and even certain types of exercises to enhance overall treatment outcomes.
Will PENS reduce my need for pain medications?
Yes, many patients who undergo PENS therapy report a reduced reliance on pain medications, including non-opioid analgesics, due to the significant pain relief PENS provides.
Can PENS help if I have sciatica in both legs?
Yes, PENS can be applied to both sides if necessary, although sciatica typically affects one side. The therapy can be customized to target the specific nerves responsible for the pain in each leg.
Is there a risk of nerve damage from PENS therapy?
The risk of nerve damage from PENS is extremely low. The procedure is minimally invasive, and the needles are carefully placed to avoid injury to the nerve or surrounding tissues.e
Can PENS therapy be used for other types of pain?
Yes, PENS is also used to treat various types of chronic pain, including lower back pain, osteoarthritis, and pain from neuropathy. It is effective in addressing pain that originates from nerve irritation.
Is PENS covered by insurance?
Many insurance plans, including Medicare, may cover PENS therapy, particularly if other treatments have not been successful. It’s important to check with your insurance provider for specific coverage details.
What should I do if my sciatica symptoms worsen after PENS therapy?
While it is uncommon for symptoms to worsen after PENS, any increase in pain should be promptly reported to your healthcare provider. They can adjust your treatment plan accordingly.
Can sciatica return after PENS therapy?
While PENS therapy can provide significant pain relief, sciatica may return if the underlying cause (such as a herniated disc or degenerative disease) persists or worsens. Continuous management and lifestyle changes can help mitigate recurrences.
What lifestyle changes can help prevent sciatica from recurring?
Regular exercise to strengthen your core muscles, maintaining good posture, avoiding prolonged sitting, and practicing proper lifting techniques can help prevent future episodes of sciatica.
I am fellowship trained in joint replacement surgery, metabolic bone disorders, sports medicine and trauma. I specialize in total hip and knee replacements, and I have personally written most of the content on this page.
You can see my full CV at my profile page.
