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Peripherally Induced Reconditioning of the Central Nervous System: A Proposed Mechanistic Theory for Sustained Relief of Chronic Pain with Percutaneous Peripheral Nerve Stimulation

Authors Deer TR, Eldabe S, Falowski SM, Huntoon MA, Staats PS, Cassar IR, Crosby ND, Boggs JW

Received 16 December 2020

Accepted for publication 26 February 2021

Published 12 March 2021 Volume 2021:14 Pages 721—736


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 4

Editor who approved publication: Dr Dawood Sayed

Timothy R Deer,1 Sam Eldabe,2 Steven M Falowski,3 Marc A Huntoon,4 Peter S Staats,5 Isaac R Cassar,6 Nathan D Crosby,6 Joseph W Boggs6

1The Spine and Nerve Center of the Virginias, Charleston, WV, USA; 2Department of Pain Medicine, The James Cook University Hospital, Middlesbrough, UK; 3Department of Neurosurgery, Neurosurgical Associates of Lancaster, Lancaster, PA, USA; 4Anesthesiology, Virginia Commonwealth University Medical Center, Richmond, VA, USA; 5Premier Pain Centers, Shrewsbury, NJ, USA; 6SPR Therapeutics, Cleveland, OH, USA

Correspondence: Timothy R Deer
The Spine and Nerve Center of the Virginias, 400 Court Street, Suite 100, Charleston, WV, 25301, USA
Tel +1 304/347-6141
Fax +1 304/347-6855
Email [email protected]

Abstract: Peripheral nerve stimulation (PNS) is an effective tool for the treatment of chronic pain, although its efficacy and utilization have previously been significantly limited by technology. In recent years, purpose-built percutaneous PNS devices have been developed to overcome the limitations of conventional permanently implanted neurostimulation devices. Recent clinical evidence suggests clinically significant and sustained reductions in pain can persist well beyond the PNS treatment period, outcomes that have not previously been observed with conventional permanently implanted neurostimulation devices. This narrative review summarizes mechanistic processes that contribute to chronic pain, and the potential mechanisms by which selective large diameter afferent fiber activation may reverse these changes to induce a prolonged reduction in pain. The interplay of these mechanisms, supported by data in chronic pain states that have been effectively treated with percutaneous PNS, will also be discussed in support of a new theory of pain management in neuromodulation: Peripherally Induced Reconditioning of the Central Nervous System (CNS).

Keywords: chronic pain, neuromodulation, peripheral nerve stimulation, cortical plasticity, peripherally induced reconditioning, mechanism of action

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