Long-term benefits of ultrasound-guided percutaneous electrical nerve stimulation for chronic lateral elbow pain: a randomized controlled trial

Arch Phys Med Rehabil. 2026 Jul 15:S0003-9993(26)00815-4. doi: 10.1016/j.apmr.2026.07.006. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the mid- and long-term benefits of percutaneous electrical nerve stimulation applied to the radial nerve, combined with exercise, in patients with chronic lateral elbow pain, focusing on pain intensity, pain-related disability, psychological outcomes, and self-perceived change.

DESIGN: A randomized, double-blinded, sham-controlled clinical trial SETTING: University facilities.

PARTICIPANTS: Forty-nine participants with lateral elbow pain were randomly assigned to percutaneous electrical nerve stimulation or sham percutaneous electrical nerve stimulation groups.

INTERVENTION: A four-week exercise program with one weekly session of percutaneous electrical nerve stimulation or sham percutaneous electrical nerve stimulation targeting the radial nerve in patients with chronic lateral elbow pain.

OUTCOME MEASURES: Numeric Pain Rating Scale for pain, Patient-Rated Tennis Elbow Evaluation for disability, and psychological and self-perceived outcomes including the Tampa Scale of Kinesiophobia (11-item version), Pain Catastrophizing Scale, and Global Rating of Change, assessed over one year.

RESULTS: Percutaneous electrical nerve stimulation significantly outperformed sham treatment across all primary and secondary outcomes. The percutaneous electrical nerve stimulation group demonstrated large and sustained improvements in pain (Numeric Pain Rating Scale: -25.5 points), function (Patient-Rated Tennis Elbow Evaluation: -25.4 points; Disabilities of the Arm, Shoulder and Hand: -24.5 points), Tampa Scale of Kinesiophobia (11-item version), and Pain Catastrophizing Scale, with all differences exceeding minimal clinically important differences. More than 90% of participants receiving percutaneous electrical nerve stimulation reported moderate-to-large perceived improvement (Global Rating of Change of 4 or higher) at one-year follow-up. No serious adverse events were reported.

CONCLUSIONS: Ultrasound-guided percutaneous electrical nerve stimulation targeting the radial nerve, when combined with exercise, appears to produce significant, clinically meaningful, and sustained improvements in pain, function, and psychological health in individuals with chronic lateral elbow pain. These findings may support integrating percutaneous electrical nerve stimulation into evidence-based physiotherapy for this condition.

PMID:42457107 | DOI:10.1016/j.apmr.2026.07.006