Division of Pain Medicine, Department of Anesthesia, New York University Grossman School of Medicine, New York, NY, USA.
Curr Neuropharmacol. 2024;22(1):65-71. doi: 10.2174/1570159X21666230803100400.
The percutaneous technique of electrode insertion in the vicinity of the greater occipital nerves to treat occipital neuralgia was first described in the 1990s by Weiner and Reed. This subsequently stimulated awareness of peripheral nerve stimulation (PNS). The more recent advent emergence of a minimally invasive percutaneous approach by way of using ultrasound has further increased the interest in PNS as a viable alternative to more invasive techniques. PNS has become more popular recently and is increasingly used to treat various pain conditions. Its foundation is fundamentally based on the gate control theory, although the precise mechanism underlying its analgesic effect is still indefinite. Studies have demonstrated the peripheral and central analgesic mechanisms of PNS by modulating the inflammatory pathways, the autonomic nervous system, the endogenous pain inhibition pathways, and the involvement of the cortical and subcortical areas. Peripheral nerve stimulation exhibits its neuromodulatory effect both peripherally and centrally. Further understanding of the modulation of PNS mechanisms can help guide stimulation approaches and parameters to optimize the use of PNS. his chapter aims to review the background and mechanisms of PNS modulation. PNS is becoming one of the most diverse therapies in neuromodulation due to rapid evolution and expansion. It is an attractive option for clinicians due to the simplicity and versatility of procedures that can be combined with other neuromodulation treatments or used alone. It has a distinct role in the modulation of functional conditions.
经皮电极插入技术在枕大神经附近治疗枕神经痛的方法最初是由 Weiner 和 Reed 在 20 世纪 90 年代描述的。这随后引起了人们对周围神经刺激（PNS）的关注。最近，通过使用超声的微创经皮方法的出现，进一步增加了人们对 PNS 的兴趣，将其作为更具侵入性技术的可行替代方案。PNS 最近变得越来越流行，并且越来越多地用于治疗各种疼痛状况。其基础从根本上基于门控理论，尽管其镇痛作用的确切机制仍不确定。研究通过调节炎症途径、自主神经系统、内源性疼痛抑制途径以及皮质和皮质下区域的参与，证明了 PNS 的外周和中枢镇痛机制。PNS 通过外周和中枢都表现出其神经调节作用。进一步了解 PNS 机制的调节可以帮助指导刺激方法和参数，以优化 PNS 的使用。本章旨在综述 PNS 调节的背景和机制。由于快速发展和扩展，PNS 正在成为神经调节中最多样化的治疗方法之一。由于程序的简单性和多功能性，它对临床医生具有吸引力，可以与其他神经调节治疗结合使用，也可以单独使用。它在功能状况的调节中具有独特的作用。
