Percutaneous electrical nerve stimulation (PENS) involves delivering electrical currents through fine filiform needles inserted near tissues such as muscles, ligaments, or nerves. It has been explored for various chronic pain conditions affecting the cervical and lumbar spine, as well as the upper and lower limbs. Despite its growing clinical use, the overall quality of evidence supporting PENS for chronic musculoskeletal pain remains limited. Most studies have applied the technique directly over nerve structures, and while some reviews have shown greater pain reduction compared to transcutaneous electrical nerve stimulation (TENS), the superiority of PENS has not been conclusively demonstrated. Research specifically examining its application on nerve tissues, particularly in the upper limbs, remains scarce. Some preliminary and single-case studies have reported improvements in pain and disability following PENS directed at the radial nerve, but these findings are limited by small sample sizes and the absence of control groups. The physiological mechanisms underlying PENS are still not fully understood, though both peripheral and central processes are believed to be involved. Evidence suggests that PENS can reduce local sensitivity to pressure pain through peripheral mechanisms and may also enhance descending inhibitory control by activating conditioned pain modulation at the central level. However, further studies are necessary to clarify these effects.
Since to date, limited research has specifically examined the optimal PENS dosage, the present study aimed to compare two PENS dosage for improving muscle strength and pain pressure thresholds.
Presence of at least one latent myofascial trigger point (MTrP) in the infraspinatus muscle, identified according to the most recent Delphi consensus criteria.
Ability to read, understand, and sign the written informed consent form.
Current pharmacological treatment that may affect muscle tone.
History of shoulder or spinal surgery.
Traumatic disorders such as whiplash-associated injuries, dislocations, or fractures.
Neuropathies, including radiculopathies or myelopathies.
Parallel
Percutaneous electrical nerve stimulation: High frequency
Other interventionA single PENS session will be applied under ultrasound guidance using sterile, single-use filiform needles placed in the suprascapular and axillary nerves and connected to an electrostimulator APSe4 (Agupunt, Barcelona). Dosage will be: 100 Hz frequency, 250 µs pulse width, 5-second stimulation followed by 55-second rest, repeated five times
Percutaneous electrical nerve stimulation: Low frequency
Other interventionA single PENS session will be applied under ultrasound guidance using sterile, single-use filiform needles placed in the suprascapular and axillary nerves and connected to an electrostimulator APSe4 (Agupunt, Barcelona). Dosage will be: 2 Hz frequency, 250 µs pulse width, 10 minutes duration, with an intensity (mA) sufficient to elicit a visible motor response while remaining comfortable for the patient.
Muscle strength
Shoulder external rotator strength will be assessed using a handheld dynamometer (TruStrength, Hawkin Dynamics, USA), previously validated for measuring isometric muscle contraction strength. Participants will perform a standardized isometric external rotation test in a seated position with the elbow flexed at 90°.
Muscle strength
Shoulder external rotator strength will be assessed using a handheld dynamometer (TruStrength, Hawkin Dynamics, USA), previously validated for measuring isometric muscle contraction strength. Participants will perform a standardized isometric external rotation test in a seated position with the elbow flexed at 90°.
Pain Pressure Thresholds - Latent MTrP
The assessment of pressure pain thresholds (PPT) at the myofascial trigger point (MTrP) will be evaluated three times at each measurement site using a analog algometer, applying a pressure rate of approximately 5 N/s.
Pain Pressure Thresholds - Latent MTrP
The assessment of pressure pain thresholds (PPT) at the myofascial trigger point (MTrP) will be evaluated three times at each measurement site using a analog algometer, applying a pressure rate of approximately 5 N/s.
Pain Pressure Thresholds - Tibialis anterior
The assessment of pressure pain thresholds (PPT) at a distal location (Tibia's anterior) will be evaluated three times at each measurement site using a analog algometer, applying a pressure rate of approximately 5 N/s.
Pain Pressure Thresholds - Tibialis anterior
The assessment of pressure pain thresholds (PPT) at a distal location (Tibia's anterior) will be evaluated three times at each measurement site using a analog algometer, applying a pressure rate of approximately 5 N/s.
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Universidad Complutense de Madrid
Lead sponsor
Universidad Rey Juan Carlos
Collaborator
