Percutaneous Neuromodulation Therapy (PNT)

Peer Reviewed

Posture at DeskBack pain, one of the leading reasons people seek medical care, affects most people at some point in their lives. The most common causes of back pain are sprains, strains, or spasms usually brought on by improper lifting techniques, poor posture, or an unhealthy ergonomic environment. Spinal conditions such as stenosis, osteoarthritis, osteoporosis, or disc problems can also lead to serious and often chronic back pain.

Typical treatments for chronic back pain include:

  • Medications such as NSAIDs, steroids, and anti-depressants
  • Injections such as epidural steroid injections, nerve blocks, and trigger point injections
  • Physical therapy
  • Biofeedback
  • Newer technologies such as IDET (Intradiscal Electrothermoplasty) and Radiofrequency Discal Nucleoplasty which use fine-gauge needles and either heat or radio waves to treat pain
  • In rare cases, surgery or the implanting of pumps and stimulators under the skin that administer medications or electrical pulses to treat pain

Today, another option recently approved by the Food and Drug Administration (FDA) is available for patients suffering from chronic low back or neck pain. It is a non-surgical treatment called Percutaneous Neuromodulation Therapy (PNT).

How PNT Works
It is now understood that even a single episode of back pain can cause the nerve cells that transmit pain signals to become "hypersensitive", even after the injury has healed. This can lead to repeated bouts of pain even without repeated injury. Electrical stimulation is one therapy that, when applied to the deep tissues in the back, can provide relief for certain types of chronic pain. PNT is that type of therapy.

PNT uses very thin needle electrodes that are inserted directly into the deep tissues in the area of the spine causing the pain. The specific placement of these electrodes and the delivery of electrical stimulation help "calm" the hypersensitivity of the nerves.

For patients suffering from chronic or recurring low back pain, especially those who have tried other conservative pain management treatments with little or no success, this may provide the relief they are looking for.

The Benefits of PNT
PNT is a non-invasive, low-risk procedure that can help treat pain in its early stages. This may be able to reduce the number of patients who progress to more debilitating, long-term pain that can persist for months or even years. PNT treatments and the pain relief they provide may also help patients increase their activity levels, improve their quality of sleep, and reduce their need for pain medications.

The Procedure
PNT is a non-surgical procedure that can be done in a physician's office.

The patient lies face down on an examination table. Using light adhesive strips, 10 electrodes are placed on the skin in the affected area of the back. These electrodes, called "Safeguides", include ultra-thin needles (three times thinner than a human hair) that are inserted into the skin. The physician then administers electrical stimulation to the nerves through the needle electrodes. Patients may feel a warm tingling sensation where the electrodes are placed, but the discomfort should be minimal. PNT treatment sessions only take about 30 minutes. Most patients report no side effects from the procedure and are immediately able to return to normal daily activities or work.

Depending on the complexity of the spinal condition, it may take several PNT sessions for patients to feel any measurable pain relief. In fact, most patients should be ready to commit to a course of at least 3-4 sessions to effectively evaluate the therapy. Treatments may be done 1-2 times per week and can be used alone or in conjunction with other pain management therapies.

Talk to Your Doctor About PNT
If you are suffering from chronic neck or back pain, and think PNT might be helpful, talk to your physician. Together you can decide if the procedure is right for you.

Updated on: 02/28/17
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Nerve Blocks: Medication Injections
Claudio A. Feler, MD
Readers of this article should keep in mind that the concept of back pain is somewhat oversimplified in this article. For example, there are many causes for this anatomic location of pain, including: direct nerve injury, nociceptor barrage, referred phenomenon; or as a result of denervation. None of these problems are treatable with a single therapy.

Additionally, readers should be aware that there is debate as to the effectiveness of IDET treatment.

Finally, it is noted that PNT has not been examined, to my knowledge, in a validated prospective study. Further scientific validation of the treatment is undoubtedly needed.

All of that said, patients are encouraged to discuss all pain management options carefully with their treating doctor, and even to seek a second opinion if necessary.

Continue Reading:

Nerve Blocks: Medication Injections

Blocks with local anesthetic can be used to control acute pain. Blocks often provide diagnostic information, helping to determine the source of the pain.
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