Application of Percutaneous Electrical Nerve Stimulation (PENS) in musculoskeletal disorders: a narrative review
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Abstract
Background and objectives: Various studies have identified that percutaneous electrical nerve stimulation (PENS) has a positive impact on pain modulation and functional improvement in different musculoskeletal disorders. In recent years, there has been an increase in research analyzing its effectiveness in the treatment of pain and functionality. This narrative review aims to analyze the available evidence from the last five years regarding the effectiveness of PENS in pain reduction and functional improvement, the proposed mechanisms of action, and the degree of standardization of the treatment parameters used in clinical practice.
Methods: A search was conducted in the PubMed, Cochrane Library, and SciELO databases, including randomized clinical trials, observational studies, and systematic reviews published between 2020 and 2025. Articles in English and Spanish that assessed the application of PENS in adults with musculoskeletal disorders were included. The methodological quality of the studies was evaluated using the GRADE scale.
Results: Studies were identified that applied PENS in conditions such as chronic low back pain, cervical myofascial pain, and knee pain. Most studies reported statistically significant improvements in both pain intensity and functionality, although the effectiveness of the technique varied depending on the stimulation parameters used and the methodological characteristics of each study.
Discussion: Evidence suggests that ultrasound-guided PENS can produce statistically significant improvements in pain and function in the short term. However, there remains significant variability in application parameters and treatment dosages, which limits comparability between studies and the formulation of solid clinical recommendations. Additionally, its use has been explored in healthy subjects for the purpose of enhancing muscle performance, although there are still methodological challenges in the standardization of protocols and in the evaluation of its long-term effects.
Conclusion: The most recent evidence confirms that PENS is a promising tool in the field of physiotherapy. However, it is necessary to conduct studies with greater methodological rigor to optimize its application parameters and assess its effectiveness in the medium and long term.
Keywords
- Percutaneous electrical nerve stimulation
- percutaneous neuromodulation
- musculoskeletal disorders
- physiotherapy
- systematic review
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