Plasticity‐Inducing Percutaneous Peripheral Nerve Stimulation for Treating Neck Pain: A Blinded, Randomised Clinical Trial

Background Percutaneous peripheral nerve stimulation (pPNS) protocols that induce synaptic plasticity in animals were recently shown to produce hypoalgesia in humans. However, whether they can relieve pain in a clinical population remains unexplored. Here we investigated the effects of these pPNS protocols in pain symptoms of participants suffering from non‐specific neck pain. Methods 45 participants were divided into three groups: percutaneous Sensory‐Threshold burst High‐Frequency Stimulation (ST‐bHFS), percutaneous Motor‐Threshold Theta‐Burst Stimulation (MT‐TBS) or an active control group receiving 80 Hz TENS. A verbal numerical rating scale (VRNS) was used to assess spontaneous and movement‐induced pain. Pain was also evaluated during the week before and the week after treatment, along with maximal strength and electromyography of the upper trapezius. Results ST‐bHFS produced a clinically relevant and significant reduction in spontaneous pain (1.8 ± 1.6 VRNS, p < 0.001), not detected in MT‐TBS (0.8 ± 1.9, p = 0.105) or TENS (0.5 ± 1.3, p = 0.185). All protocols reduced movement‐induced pain (MT‐TBS 1.9 ± 1.6, p < 0.001; ST‐bHFS 1.7 ± 2.2, p = 0.009; TENS 1.4 ± 1.5, p = 0.002), although the reduction in the TENS group did not reach clinical relevance. One week post‐treatment, a clinically relevant and significant pain reduction was still present in the pPNS groups (MT‐TBS 2.0 ± 1.3, p < 0.001; ST‐bHFS 1.7 ± 2.6, p = 0.041), but not in the TENS group (0.7 ± 1.9, p = 0.350). Maximal strength increased significantly in TENS (3.5 ± 5.1 kg, p = 0.019) and MT‐TBS groups (2.8 ± 4.2, p = 0.021), without electromyographic changes. Conclusions pPNS protocols reduced pain symptomatology in patients with non‐specific neck pain. Contrary to TENS, ST‐bHFS reduced spontaneous pain and pain reduction lasted for a week in both pPNS groups. These results hold promise for improving the use of pPNS through translation of fundamental pain neuroscience. Significance Statement Plasticity‐inducing protocols applied through percutaneous peripheral nerve stimulation are an effective non‐pharmacological treatment. They represent a clinically relevant option for pain management that could influence clinical practice as well as future fundamental and clinical research. Trial Registration ClinicalTrials.gov identifier: NCT06153875