Background & Aims

In 2022, The National Institute of Clinical Excellence, recommended multifidus muscle neurostimulation for refractory non-specific chronic low back pain in adults, that involves implanting a pulse generator under the skin of the upper buttock or lower back, which the person can use to manage their pain. This allowed pain clinics to offer the treatment, with special arrangements for clinical governance, consent, and audit or research, to monitor effectiveness, safety and side effects.
At East Kent Hospitals Pain clinic, we offer the treatment to patients with refractory low back pain, having similar selection criteria as the industry funded study that forms the basis of the present understanding of treatment.
The aim of the audit is to compare the outcome data observed in our patients (n = 25) to that of the published study for similarities and variations that can be used for service improvement.

Methods

Patients with chronic low back pain (> 6 months) who have not responded to physiotherapy, medicines, or pain management, with MRI scan and physical assessment showing Multifidus atrophy and dysfunction, respectively, and not having any contraindications (previous spinal surgery or radiofrequency denervation of dorsal primary ramus of medial branches, BMI <35, Opioids< 120mgs equivalent daily oral morphine), are discussed in a multidisciplinary team meeting, to decide if the treatment is appropriate and can be offered to the patient.
If accepted, patients attend a group introduction day to understand the treatment, equipment and what to expect. Baseline outcome measures are collected, including patient goals and plan for reduction of pain medicines.
Subsequently, they are implanted with the neurostimulator device and followed up at 6 weeks, 3 months, 6 months and 12 months, and outcome data is collected, with further support available as needed via telephone.

Results

Preliminary data of 15 patients hows a mixed picture. At this stage, it is difficult to say how varied the outcomes are likely to be (in comparison to the published study) when patient data is standardised and combined as different patients are at different stages, time-wise, in their journey.

Conclusions

Outcome data for comparison and conclusion will be available at the time of poster presentation.

References

1. Gilligan C, Volschenk W, Russo M, Green M, Gilmore C, Mehta V, Deckers K, De Smedt K, Latif U, Georgius P, Gentile J, Mitchell B, Langhorst M, Huygen F, Baranidharan G, Patel V, Mironer E, Ross E, Carayannopoulos A, Hayek S, Gulve A, Van Buyten JP, Tohmeh A, Fischgrund J, Lad S, Ahadian F, Deer T, Klemme W, Rauck R, Rathmell J, Maislin G, Heemels JP, Eldabe S; ReActiv8-B Investigators. Long-Term Outcomes of Restorative Neurostimulation in Patients With Refractory Chronic Low Back Pain Secondary to Multifidus Dysfunction: Two-Year Results of the ReActiv8-B Pivotal Trial. Neuromodulation. 2023 Jan;26(1):87-97. doi: 10.1016/j.neurom.2021.10.011. Epub 2021 Dec 18. PMID: 35088722.
2. Neurostimulation of lumbar muscles for refractory non-specific chronic low back pain
Interventional procedures guidance [IPG739]Published: 22 September 2022. https://www.nice.org.uk/guidance/IPG739/chapter/1-Recommendations.

Presenting Author

Rahul Seewal

Poster Authors

Rahul Seewal

MBBS MD FRCA FFPMRCA

East Kent Hospitals NHS Fnd Trust

Lead Author

E-mail

Topics

  • Treatment/Management: Interventional Therapies – Neuromodulation