Vicky Beveridge
Clinical Pain Service, Tauranga Hospital, Bay of Plenty DBH, Tauranga, NZ


Abstract

Percutaneous Electrical Nerve Stimulation (PENS) in the Bay of Plenty District Health Board (BOPDHB) - The First Five Cases….

V. Beveridge, S. Anis, S. Jones
Clinical Pain Service, Tauranga Hospital, Bay of Plenty District Health Board, Tauranga, NZ

Introduction: Refractory neuropathic pain is notoriously difficult to treat pharmacologically and its response to medication is variable and unpredictable (Smith, Lee, Price, & Baranowski 2013).  In addition, many medications can produce unpleasant and persistent side effects such as drowsiness, dizziness, xerostomia and constipation (Barsky, Saintfort, Rogers & Borus, 2002).  Percutaneous electrical neuromodulation is a modality that may offer a drug free treatment option for some patients. 

With the evidence available (National Institute for Health and Care Excellence, 2012), and the backing of the BOPDHB product evaluation group (PEG), we were able to evaluate how PENS might reduce neuropathic pain, reduce the level of strong analgesia required and lead to a significant improvement in quality of life. 

Methods: A literature search was made to develop guidelines on patient selection, process and documentation.  Seven patients from the chronic pain clinic were offered the opportunity to participate.  Five patients consented and arrangements were made for the manufacturer to attend for staff training.  Follow up and decisions about parameters for further treatments were made by the staff and product developer.

Results: Patients who benefited most were those who had a shorter term of neuropathic pain (5 years or less), few psychosocial issues and realistic expectations of therapy.  From this small observational study we were able to develop a robust policy, protocol and treatment pathway to guide the selection of future patients.

Conclusions: Our audit results support that a more formal product trial is justified. . 

References:
Barsky, A. J., Saintfort, R., Rogers, M. P., & Borus, J. F. (2002). Nonspecific Medication side effects and the nocebo phenomenon [Electronic version]. Journal of the American Medical Association, 287(5). doi:10.1001/jama.287.5.622.
National Institute for Health and Care Excellence. (2012). Percutaneous Electrical Nerve Stimulation for refractory neuropathic pain. In www.nice.org.uk. Retrieved January 11, 2016.
Smith, B. H., Lee, J., Price, C., & Baranowski, A. P. (2013). Neuropathic pain: a pathway for care developed by the British Pain Society [Electronic version]. British Journal of Anaesthesia, 111(1), 73-79. doi:10.1093/bja/aet206