GekoTM system to predict peripheral nerve stimulation: reality or fantasy? A prospective pilot study

Peripheral nerve stimulation (PNS) is an established therapy for chronic pain refractory to conventional treatments. Wearable devices such as the geko^TM system, originally developed to enhance lower limb circulation, may have potential as non-invasive screening tools to predict PNS candidacy. The present prospective, uncontrolled pilot study aimed to evaluate the feasibility of using the geko^TM device for predicting responsiveness to implanted PNS in patients with refractory chronic pain. Twenty patients with refractory chronic pain were treated with low-frequency common peroneal nerve stimulation (1 Hz, 6 hours/day) for 10 consecutive days using the geko^TM device. Outcomes included Numeric Rating Scale (NRS) pain scores, quality of life (QoL), oxygen saturation index (SpO2), and patient satisfaction. The primary endpoint was defined as the proportion of patients achieving a reduction of ≥50% in NRS scores. Statistical significance was evaluated using paired t-tests (p<0.05). Treatment led to significant improvements in pain, SpO₂, and QoL. Half of the patients achieved the primary endpoint, and no serious adverse events were reported. The satisfaction rate among completed cases was 100%. The geko^TM device shows promise as a non-invasive screening tool for PNS candidacy. These results should be interpreted cautiously, given the small sample size, lack of a control group, and exploratory design. Larger, controlled trials are warranted.