Magnetic Peripheral Nerve Stimulation (mPNS) for Chronic Pain

Towards accredited clinical training in brain stimulation: Proceedings from the brain stimulation subspecialty summits

The rapid development and clinical use of brain stimulation has renewed debates about whether to define and accredit a pathway for clinical subspecialty training. To address this, the Brain Stimulation Subspecialty Summits (BraSSS) were convened in 2023 and 2024, featuring international leaders in brain stimulation across psychiatry, neurology, neurosurgery, psychology, and neuroscience. Both meetings included two days of lectures and debates focused on clinical content, emerging science, and educational standards. The 2023 meeting was held at Brigham & Women's Hospital and Harvard University, where 54 attendees reached a consensus that the subspecialty is adequately developed to warrant formal recognition and initiated debates regarding the name and scope of the subspecialty. The 2024 meeting was held at Stanford University, where 56 attendees developed a content outline, organized committees, and reached a consensus to form an independent society focused on developing and maintaining unbiased accreditation standards. "Brain stimulation" was chosen democratically as the name of the subspecialty. Clinicians from multiple primary specialties may enter this subspecialty training track. While individual programs may have a specific area of focus (e.g. interventional psychiatry or epilepsy), our expectation is that accredited brain stimulation programs will provide training experiences that cross specialties and stimulation modalities. Several potential unintended consequences were discussed, and plans were developed to address them. Overall, subspecialty recognition was deemed to be beneficial to the brain stimulation field, with a goal to launch an associated society and start the process of accrediting existing US and Canadian programs in 2025.

Safety and Efficacy of Axon Therapy (SEAT Study), Utilizing Magnetic Peripheral Nerve Stimulation (mPNS) for Treatment of Neuropathic Pain

Background

Many of the current treatments for chronic neuropathic pain have variable effectiveness and known side effects. Given the prevalence of this type of intractable pain (3-17% of general population), additional therapeutic non-invasive approaches are desired. Magnetic Peripheral Nerve Stimulation (mPNS) delivered at 0.5Hz provides an effective pain relief without side effects. The objective of this randomized, controlled, multi-site clinical trial was to compare long-term safety and efficacy of mPNS in patients with chronic, intractable, post-traumatic or post-surgical neuropathic pain to comprehensive Conventional Medical Management (CMM).

Methods

A total of 65 patients with post-traumatic, post-surgical neuropathy were treated within a multicenter, randomized, clinical trial comparing the safety and effectiveness of mPNS + CMM to CMM alone. Patients were randomized 1:1 and followed through 90 days. The primary endpoint is a proportion of responders, 50% or greater reduction in pain at Day 90. The secondary endpoints included the European Quality of Life 5 Dimensions 3 Level (EQ-5D-3L) and Patient Global Impression of Change (PGIC).

Results

At 3 months, 71% of subjects were considered responders (>50% pain relief) in the mPNS + CMM group vs 13% of subjects in the CMM group. The mPNS + CMM group had a mean reduction in VAS scores at Day 90 of 3.8 points (>50% reduction), while CMM showed less than a 1-point (0.7 point) mean reduction or ~10% reduction (p < 0.0001). The EQ-5D-3L score increased in the mPNS + CMM study group, whereas the CMM group showed no improvement in EQ-5D-3L at Day 90. PGIC responder rates were 80.6% and 4.3% at Day 90 for mPNS + CMM and CMM groups, respectively.

Conclusion

mPNS + CMM was superior to CMM in a randomized prospective study when used for treatment of post-traumatic, post-surgical neuropathy. Due to the lack of other effective non-invasive treatments for neuropathic pain, mPNS should be considered much earlier in the treatment algorithm.

A Systematic Guideline by the ASPN Workgroup on the Evidence, Education, and Treatment Algorithm for Painful Diabetic Neuropathy: SWEET

Introduction

Painful diabetic neuropathy (PDN) is a leading cause of pain and disability globally with a lack of consensus on the appropriate treatment of those suffering from this condition. Recent advancements in both pharmacotherapy and interventional approaches have broadened the treatment options for PDN. There exists a need for a comprehensive guideline for the safe and effective treatment of patients suffering from PDN.

Objective

The SWEET Guideline was developed to provide clinicians with the most comprehensive guideline for the safe and appropriate treatment of patients suffering from PDN.

Methods

The American Society of Pain and Neuroscience (ASPN) identified an educational need for a comprehensive clinical guideline to provide evidence-based recommendations for PDN. A multidisciplinary group of international experts developed the SWEET guideline. The world literature in English was searched using Medline, EMBASE, Cochrane CENTRAL, BioMed Central, Web of Science, Google Scholar, PubMed, Current Contents Connect, Meeting Abstracts, and Scopus to identify and compile the evidence for diabetic neuropathy pain treatments (per section as listed in the manuscript) for the treatment of pain. Manuscripts from 2000-present were included in the search process.

Results

After a comprehensive review and analysis of the available evidence, the ASPN SWEET guideline was able to rate the literature and provide therapy grades for most available treatments for PDN utilizing the United States Preventive Services Task Force criteria.

Conclusion

The ASPN SWEET Guideline represents the most comprehensive review of the available treatments for PDN and their appropriate and safe utilization.