Abstract
Chronic low back pain remains highly prevalent, costly, and the leading cause of disability worldwide. Symptoms are complex and treatment involves an interdisciplinary approach. Due to diverse anatomical etiologies, treatment outcomes with interventional options are highly variable. A novel approach to treating chronic axial low back pain entails the use of peripheral nerve stimulation to the lumbar medial branch nerve, and this review examines the clinical data of the two different, commercially available, non-spinal neuromodulation systems. This review provides the clinician a succinct narrative that presents up-to-date data objectively. Our review found ten clinical studies, including one report of two cases, six prospective studies, and three randomized clinical trials published to date. Currently, there are different proposed mechanisms of action to address chronic axial low back pain with different implantation techniques. Evidence suggests that peripheral nerve stimulation of the lumbar medial branch nerve may be effective in improving pain and function in patients with chronic axial low back pain symptoms at short and long term follow up, with good safety profiles. Further long-term data is needed to consider this intervention earlier in the pain treatment algorithm, but initial data are promising.
Highlights
Axial low back pain (LBP) is a complex syndrome involving nociceptive and neuropathic pain with potential for compensatory structural changes in ligamentous and myofascial components, leading to a challenging diagnosis and therapeutic course in clinical practice [1]
The ReActiv8 system proposes a mechanism that is restorative and theorized to stimulate efferent signals that originate with the device and cause the multifidus muscle to contract in a rehabilitative fashion
Forty-eight results were accessed for eligibility, 38 results were excluded from Table 1 since these did not involve human clinical data and/or were duplicates
Summary
Axial low back pain (LBP) is a complex syndrome involving nociceptive and neuropathic pain with potential for compensatory structural changes in ligamentous and myofascial components, leading to a challenging diagnosis and therapeutic course in clinical practice [1]. Chronic axial LBP is defined as pain localized along the lower back region without radicular or referred pain pattern into the extremities, lasting for at least 6 months and is often associated with complex biopsychosocial factors leading to significant impairments in function and quality of life (QoL) [1, 2]. Each subsequent episode connotes a 10–15% chance for chronicity [7]. Owing to this high prevalence and incidence of recurrence, the economic impact is Lumbar Medial Branch Neuromodulation staggering, with the majority of costs deriving from missed work days, rather than direct healthcare costs. Only 50% of patients who take off work for 6 months due to LBP return to work, and an estimated 1% of the U.S population is chronically disabled because of LBP [5,6,7,8]
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