In 1999, Ghoname, et. al., conducted study about Chronic low back pain (LBP) which is a widespread condition in the United States, causing significant disability and economic burden. Current pain management strategies, including opioid and nonopioid medications, often come with adverse effects and provide limited long-term benefits. In the pursuit of effective and nonpharmacologic pain therapies, researchers investigated the potential of percutaneous electrical nerve stimulation (PENS) to alleviate long-term LBP in a groundbreaking randomized crossover study.

The study conducted at an ambulatory pain management center within a university medical center, the study enrolled 60 participants (29 men and 31 women) suffering from LBP attributed to degenerative disk disease. The study employed a randomized, single-blinded, sham-controlled, crossover design to evaluate the effectiveness of PENS compared to transcutaneous electrical nerve stimulation (TENS) and flexion-extension exercise therapies.

Each participant underwent four therapeutic modalities: sham-PENS, PENS, TENS, and exercise therapies, with each treatment lasting 30 minutes, three times a week, for three weeks. The main outcome measures included pretreatment and posttreatment visual analog scale (VAS) scores for pain, physical activity, and quality of sleep; daily analgesic medication usage; a global patient assessment questionnaire; and Health Status Survey Short Form (SF-36).

The results demonstrated that PENS outperformed the other modalities significantly in reducing VAS pain scores after each treatment session. Participants reported a mean reduction of 3.4 cm in VAS pain scores with PENS, compared to 5.5 cm with TENS, 5.6 cm with exercise therapy, and 6.4 cm with sham-PENS.

Furthermore, PENS exhibited a remarkable reduction in daily nonopioid analgesic intake, with participants consuming only 1.3 pills per day, compared to 2.6 pills per day with sham-PENS, 2.2 pills per day with TENS, and 2.6 pills per day with exercise therapy.

A striking 91% of patients identified PENS as the most effective therapy in decreasing their LBP, reaffirming its superiority over the other modalities. PENS also showed superiority in improving physical activity, sleep quality, and overall sense of well-being.

The SF-36 survey further confirmed that PENS significantly enhanced posttreatment function compared to sham-PENS, TENS, and exercise therapies.

In this groundbreaking study, PENS emerged as a highly effective nonpharmacologic pain therapy, surpassing TENS and exercise therapy in providing short-term pain relief and improved physical function for patients suffering from long-term LBP. The findings hold promise for revolutionizing the management of chronic low back pain, offering new hope for millions of individuals affected by this debilitating condition.

Reference: Ghoname, E. S. A., Craig, W. F., White, P. F., Ahmed, H. E., Hamza, M. A., Henderson, B. N., & Gatchel, R. J. (1999). Percutaneous electrical nerve stimulation for low back pain: a randomized crossover study. Jama, 281(9), 818-823.