{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T16:05:00Z","timestamp":1789142700851,"version":"build-2803163510"},"reference-count":46,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2022,11,15]]},"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:p>Peripheral nerve stimulation (PNS), a type of neuromodulatory technique, is increasingly used to treat chronic pain syndromes. PNS has also recently gained popularity as a viable adjunct analgesic modality in acute pain settings, where the practice primarily relies on using boluses or infusion of local anesthetics for nerve blockade, followed by stimulation to extend the analgesia. There is some early promise in PNS for perioperative analgesic control, but considerable obstacles must be addressed before it can be implemented into standard practice. In this daring discourse, we explore the possibilities and constraints of using the PNS paradigm in acute pain.<\/jats:p>","DOI":"10.1136\/rapm-2022-103837","type":"journal-article","created":{"date-parts":[[2023,4,20]],"date-time":"2023-04-20T05:10:24Z","timestamp":1681967424000},"page":"338-342","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Role of neuromodulation in acute pain settings"],"prefix":"10.1136","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6984-5998","authenticated-orcid":false,"given":"Ban C H","family":"Tsui","sequence":"first","affiliation":[{"name":"Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3401-4737","authenticated-orcid":false,"given":"Rajnish K","family":"Gupta","sequence":"additional","affiliation":[{"name":"Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,4,20]]},"reference":[{"key":"2025101113223757000_48.6.338.1","unstructured":"International Neuromodulation Society . Neuromodulation, or neuromodulatory effect. Available: https:\/\/www.neuromodulation.com\/neuromodulation-defined [Accessed 1 Jun 2022]."},{"key":"2025101113223757000_48.6.338.2","doi-asserted-by":"crossref","unstructured":"Graff V , Gabutti L , Treglia G , et al . Perioperative costs of local or regional anesthesia versus general anesthesia in the outpatient setting: a systematic review of recent literature. Brazilian J Anesthesiol 2021;83.doi:10.1016\/j.bjane.2021.09.012","DOI":"10.1016\/j.bjane.2021.09.012"},{"key":"2025101113223757000_48.6.338.3","doi-asserted-by":"crossref","first-page":"1369","DOI":"10.1111\/j.1526-4637.2009.00745.x","article-title":"Ultrasound-Guided permanent implantation of peripheral nerve stimulation (PNS) system for neuropathic pain of the extremities: original cases and outcomes","volume":"10","author":"Huntoon","year":"2009","journal-title":"Pain Med"},{"key":"2025101113223757000_48.6.338.4","unstructured":"FDA AccessData - SPR Therapeutics Approval for SPRINT Device. Available: https:\/\/www.accessdata.fda.gov\/cdrh_docs\/pdf18\/K181422.pdf [Accessed 24 May 2022]."},{"key":"2025101113223757000_48.6.338.5","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0000000000000481"},{"key":"2025101113223757000_48.6.338.6","doi-asserted-by":"crossref","DOI":"10.1097\/ALN.0000000000003739","article-title":"Cryoneurolysis and peripheral nerve stimulation: Comment","volume":"134","author":"Tsui","year":"2021","journal-title":"Anesthesiology"},{"key":"2025101113223757000_48.6.338.7","doi-asserted-by":"crossref","DOI":"10.1007\/s11916-021-00962-3","article-title":"Mechanism of action of peripheral nerve stimulation","volume":"25","author":"Strand","year":"2021","journal-title":"Curr Pain Headache Rep"},{"key":"2025101113223757000_48.6.338.8","doi-asserted-by":"publisher","DOI":"10.1126\/science.150.3699.971"},{"key":"2025101113223757000_48.6.338.9","doi-asserted-by":"crossref","DOI":"10.1186\/s12984-018-0474-8","article-title":"Safety of long-term electrical peripheral nerve stimulation: review of the state of the art","volume":"16","author":"G\u00fcnter","year":"2019","journal-title":"J Neuroeng Rehabil"},{"key":"2025101113223757000_48.6.338.10","doi-asserted-by":"crossref","first-page":"1590","DOI":"10.1093\/pm\/pnaa030","article-title":"A systematic literature review of peripheral nerve stimulation therapies for the treatment of pain","volume":"21","author":"Deer","year":"2020","journal-title":"Pain Med"},{"key":"2025101113223757000_48.6.338.11","doi-asserted-by":"crossref","first-page":"2111","DOI":"10.1016\/S0140-6736(21)00794-7","article-title":"Neuromodulation for chronic pain","volume":"397","author":"Knotkova","year":"2021","journal-title":"Lancet"},{"key":"2025101113223757000_48.6.338.12","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1007\/s40122-021-00306-4","article-title":"Peripheral nerve stimulation for chronic pain: a systematic review of effectiveness and safety","volume":"10","author":"Helm","year":"2021","journal-title":"Pain Ther"},{"key":"2025101113223757000_48.6.338.13","first-page":"E131","article-title":"Peripheral nerve stimulation in pain management: a systematic review","volume":"24","author":"Xu","year":"2021","journal-title":"Pain Physician"},{"key":"2025101113223757000_48.6.338.14","doi-asserted-by":"crossref","first-page":"e588","DOI":"10.1097\/PR9.0000000000000588","article-title":"Postoperative pain-from mechanisms to treatment","volume":"2","author":"Pogatzki-Zahn","year":"2017","journal-title":"Pain Rep"},{"key":"2025101113223757000_48.6.338.15","doi-asserted-by":"crossref","first-page":"e161","DOI":"10.1097\/SLA.0000000000000392","article-title":"Surgically induced neuropathic pain: understanding the perioperative process","volume":"261","author":"Deumens","year":"2015","journal-title":"Ann Surg"},{"key":"2025101113223757000_48.6.338.16","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2044.2011.06626.x"},{"key":"2025101113223757000_48.6.338.17","doi-asserted-by":"publisher","DOI":"10.1097\/01.anes.0000270759.11086.e7"},{"key":"2025101113223757000_48.6.338.18","doi-asserted-by":"publisher","DOI":"10.1042\/BST0370318"},{"key":"2025101113223757000_48.6.338.19","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1177\/2049463717736492","article-title":"Chronic post-amputation pain: peri-operative management - Review","volume":"11","author":"Srivastava","year":"2017","journal-title":"Br J Pain"},{"key":"2025101113223757000_48.6.338.20","doi-asserted-by":"crossref","DOI":"10.4103\/joacp.JOACP_126_17","article-title":"Strategies for prevention of lower limb post-amputation pain: a clinical narrative review","volume":"34","author":"Ahuja","year":"2018","journal-title":"J Anaesthesiol Clin Pharmacol"},{"key":"2025101113223757000_48.6.338.21","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1111\/papr.12539","article-title":"Neurostimulation for postsurgical analgesia: a novel system enabling ultrasound-guided percutaneous peripheral nerve stimulation","volume":"17","author":"Ilfeld","year":"2017","journal-title":"Pain Pract"},{"key":"2025101113223757000_48.6.338.22","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200603000-00028"},{"key":"2025101113223757000_48.6.338.23","doi-asserted-by":"crossref","DOI":"10.1097\/PR9.0000000000000627","article-title":"Risk stratification for the development of chronic postsurgical pain","volume":"2","author":"Schug","year":"2017","journal-title":"Pain Rep"},{"key":"2025101113223757000_48.6.338.24","doi-asserted-by":"publisher","DOI":"10.1111\/ejn.13005"},{"key":"2025101113223757000_48.6.338.25","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1097\/ALN.0000000000003532","article-title":"Cryoneurolysis and percutaneous peripheral nerve stimulation to treat acute pain","volume":"133","author":"Ilfeld","year":"2020","journal-title":"Anesthesiology"},{"key":"2025101113223757000_48.6.338.26","doi-asserted-by":"crossref","first-page":"347","DOI":"10.2217\/pmt-2018-0094","article-title":"Percutaneous peripheral nerve stimulation for acute postoperative pain","volume":"9","author":"Gabriel","year":"2019","journal-title":"Pain Manag"},{"key":"2025101113223757000_48.6.338.27","doi-asserted-by":"crossref","first-page":"740-741","DOI":"10.1007\/s12630-021-01917-3","article-title":"Augmenting conventional regional nerve block with peripheral neuromodulation using a perineural stimulating catheter","volume":"68","author":"Ip","year":"2021","journal-title":"Can J Anaesth"},{"key":"2025101113223757000_48.6.338.28","doi-asserted-by":"crossref","first-page":"e01487","DOI":"10.1213\/XAA.0000000000001487","article-title":"Feasibility of combining nerve stimulation and local anesthetic infusion to treat acute Postamputation pain: a case report of a hybrid technique","volume":"15","author":"Sondekoppam","year":"2021","journal-title":"A A Pract"},{"key":"2025101113223757000_48.6.338.29","first-page":"69-72","article-title":"Pain management using a novel hybrid technique of perineural stimulation combined with regional anaesthesia through a stimulating perineural catheter for below knee amputation","volume":"9","author":"Ip","year":"2021","journal-title":"Anaesth Rep"},{"key":"2025101113223757000_48.6.338.30","doi-asserted-by":"crossref","DOI":"10.1136\/rapm-2021-103220","article-title":"Single perineural catheter for hybrid technique of combined peripheral nerve stimulation and regional local anesthetic nerve block to manage phantom limb pain: time to jump on the neuromodulation bandwagon?","volume":"47","author":"Miser","year":"2022","journal-title":"Reg Anesth Pain Med"},{"key":"2025101113223757000_48.6.338.31","doi-asserted-by":"crossref","DOI":"10.1186\/s13018-016-0506-7","article-title":"Ultrasound-Guided percutaneous peripheral nerve stimulation for analgesia following total knee arthroplasty: a prospective feasibility study","volume":"12","author":"Ilfeld","year":"2017","journal-title":"J Orthop Surg Res"},{"key":"2025101113223757000_48.6.338.32","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0000000000000819"},{"key":"2025101113223757000_48.6.338.33","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1111\/ner.12790","article-title":"A feasibility study of percutaneous peripheral nerve stimulation for the treatment of postoperative pain following total knee arthroplasty","volume":"22","author":"Ilfeld","year":"2019","journal-title":"Neuromodulation"},{"key":"2025101113223757000_48.6.338.34","doi-asserted-by":"publisher","DOI":"10.1136\/rapm-2018-100121"},{"key":"2025101113223757000_48.6.338.35","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1111\/ner.12851","article-title":"Ultrasound-Guided percutaneous peripheral nerve stimulation: neuromodulation of the femoral nerve for postoperative analgesia following ambulatory anterior cruciate ligament reconstruction: a proof of concept study","volume":"22","author":"Ilfeld","year":"2019","journal-title":"Neuromodulation"},{"key":"2025101113223757000_48.6.338.36","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1097\/ALN.0000000000003776","article-title":"Percutaneous peripheral nerve stimulation (neuromodulation) for postoperative pain: a randomized, sham-controlled pilot study","volume":"135","author":"Ilfeld","year":"2021","journal-title":"Anesthesiology"},{"key":"2025101113223757000_48.6.338.37","article-title":"Percutaneous neuromodulation of the brachial plexus and sciatic nerve for the treatment of acute pain following surgery: secondary outcomes from a multicenter, randomized, controlled pilot study","author":"Ilfeld","year":"2021","journal-title":"Neuromodulation"},{"key":"2025101113223757000_48.6.338.38","doi-asserted-by":"publisher","DOI":"10.1136\/rapm-2019-100937"},{"key":"2025101113223757000_48.6.338.39","doi-asserted-by":"publisher","DOI":"10.1136\/rapm-2018-100109"},{"key":"2025101113223757000_48.6.338.40","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1080\/17434440.2021.1877134","article-title":"Acute postoperative pain management with percutaneous peripheral nerve stimulation: the sprint neuromodulation system","volume":"18","author":"Gabriel","year":"2021","journal-title":"Expert Rev Med Devices"},{"key":"2025101113223757000_48.6.338.41","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1097\/ALN.0000000000003740","article-title":"Cryoneurolysis and peripheral nerve stimulation: reply","volume":"134","author":"Ilfeld","year":"2021","journal-title":"Anesthesiology"},{"key":"2025101113223757000_48.6.338.42","unstructured":"2021 StimRouter neuromodulation system reimbursement reference guide. Available: https:\/\/stimrouter.com\/wp-content\/uploads\/2020\/07\/CY2021-StimRouter-Neuromodulation-System_Clinical-Reimbursement-Reference-Guide_02.02.21.pdf [Accessed 24 May 2022]."},{"key":"2025101113223757000_48.6.338.43","unstructured":"SPRINT\u00ae peripeheral nerve stimulation (PNS) system ambulatory surgery center (ASC) reference guide, 2022. Available: https:\/\/www.sprtherapeutics.com\/wp-content\/uploads\/2022\/01\/2022-SPRINT-ASC-Reference-Guide-MA-000002-02.pdf [Accessed 24 May 2022]."},{"key":"2025101113223757000_48.6.338.44","unstructured":"ASRA Coder (Version 1.0.6) [Mobile app], American Society of Regional Anesthesia and Pain Medicine, 2022. Available: https:\/\/apps.apple.com\/ca\/app\/asra-coder\/id1522708163"},{"key":"2025101113223757000_48.6.338.45","doi-asserted-by":"publisher","DOI":"10.3171\/2017.3.FOCUS1746"},{"key":"2025101113223757000_48.6.338.46","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1016\/0141-5425(90)90004-7","article-title":"Local anaesthetic block protects against electrically-induced damage in peripheral nerve","volume":"12","author":"Agnew","year":"1990","journal-title":"J Biomed Eng"}],"container-title":["Regional Anesthesia &amp; Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rapm-2022-103837","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T20:22:47Z","timestamp":1760214167000},"score":1,"resource":{"primary":{"URL":"https:\/\/rapm.bmj.com\/lookup\/doi\/10.1136\/rapm-2022-103837"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,20]]},"references-count":46,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2023,4,20]]},"published-print":{"date-parts":[[2023,6]]}},"alternative-id":["10.1136\/rapm-2022-103837"],"URL":"https:\/\/doi.org\/10.1136\/rapm-2022-103837","relation":{},"ISSN":["1098-7339","1532-8651"],"issn-type":[{"value":"1098-7339","type":"print"},{"value":"1532-8651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,20]]}}}