The field of physiotherapy has evolved considerably in recent years following the emergence of new techniques and the technological development of devices that contribute to improving intervention and evaluation of patients with a variety of pathologies.
One of these techniques is ultrasound-guided Percutaneous Neuromodulation (PNM). This is defined as the application through a needle with ultrasound guidance of a low or medium frequency electric current. As a tool in physiotherapy and with a therapeutic objective, it is used to search for a sensory and/or motor response from a peripheral nerve at some point in its trajectory, or from a muscle at a motor point.
In physiotherapy, ultrasound-guided Percutaneous Neuromodulation (PNM) helps in the treatment of pain, both in patients who suffer from chronic pain, as well as those who have suffered a traumatic accident or surgical intervention.
To perform this technique, a TENS (transcutaneous electrical nerve stimulation) current is used, applied invasively by means of an acupuncture needle inserted directly near the peripheral nerve.
The application of TENS has an analgesic effect, activating inhibitory neurotransmitter mechanisms such as the release of B-endorphins, activation of opioid receptors, cannabinoid substances and serotonin. In turn, it decreases the secretion of excitatory neurotransmitters such as glutamate and reduces the amount of inflammatory cytokines and glial activity, inhibiting the activity of microglia and reducing the expression of astrocytes in the spinal cord.
The use of this type of current, applied percutaneously and with certain parameters, depending on the type of nerve fibre to which it is applied, results in a quick and effective decrease in pain in the patient. When referring to pain, it is necessary to take into account its multifactorial perspective, to address each case and each patient individually.
Ultrasound-guided Percutaneous Neuromodulation (PNM) is a specific, painless and safe tool since it is performed with ultrasound control and under aseptic conditions.
To perform this technique in the consulting room and to be as accurate as possible, a high-end ultrasound machine is required in addition to extensive knowledge of human anatomy.
When is it used?
- Arthrosis of the knee
- Spine and lower back pain
- Rotator cuff tendinopathies of the shoulder
- After surgical interventions such as total knee replacement or meniscectomy
- Anterior cruciate ligament interventions
- Neuropathies
Its application, combined with other physiotherapy techniques, enhances its effect. Therefore, for the treatment of pain in patients with injuries or dysfunctions, a competent physiotherapist and therapeutic exercise will play a leading role.
Mr. Javier Valero Ortiz
Physiotherapist and Director at Valero Clinic
