Background & Aims

Axial low back pain is a leading cause of disability in the modern world [1, 2] with the majority of patients receiving conservative therapies (medications, physical therapy) before consideration of interventions and surgery. In patients that are non-responsive to conservative measures, management of symptoms using neuromodulation may provide adequate relief. One neuromodulation technique that has been growing in application for chronic pain management is Peripheral Nerve Stimulation (PNS). We report a case on utilization of PNS for the successful management of chronic low back pain including pre- and post-operative pain scores.

Methods

A retrospective case review of the patient who received PNS implantation for chronic axial lumbar spine pain was performed at an academic pain clinic. The patient had failed conservative treatment as well as surgical management. Numerical Pain Scores (NRS) were collected prior to PNS implantation and at immediate post-op, 1 month, and 2 month post-implantation.

Results

The patient is an 80 year old male with history of sleep apnea on CPAP, coronary artery disease, cardiomyopathy status-post AICD, history of renal carcinoma, and chronic low back pain status-post lateral interbody fusion of L2-L3 and L3-S1 spinal decompression and fusion who presented to our clinic for management of symptoms. The patient trialed physical therapy, interventions (epidural steroid injections, medial branch blocks, intrathecal trials) with insignificant relief. Patient underwent percutaneous implantation of peripheral nerve stimulator leads bilaterally on L1 medial branches. Retrospective analysis of the patient’s NRS were reviewed, which showed an overall downtrend with scores of 8/10 and 0/10 pre- and post-operatively, 5/10 at 1 month post-op, and 0/10 at 2 month post-op. Additionally, the patient went from 7.5 morphine milligram equivalence (MME)/day to 0 MME/day. Patient has subsequently remained off opioid medication since PNS lead removal over 6 months ago to-date.

Conclusions

We suggest PNS may provide clinically significant long-term reductions in chronic axial low back pain. Given the minimally invasive nature of PNS, it may be used safely and earlier in treatment algorithms unresponsive to other conservative treatments [3].

References

1. Dutmer AL, Schiphorst Preuper HR, Soer R, et al. Personal and societal impact of low back pain: the Groningen Spine Cohort. Spine 2019; 44: E1443–E1451.

2. Safiri S, Kolahi AA, Hoy D, Buchbinder R, Mansournia MA, Bettampadi D, Ashrafi-Asgarabad A, Almasi-Hashiani A, Smith E, Sepidarkish M, Cross M, Qorbani M, Moradi-Lakeh M, Woolf AD, March L, Collins G, Ferreira ML. Global, regional, and national burden of neck pain in the general population, 1990-2017: systematic analysis of the Global Burden of Disease Study 2017. BMJ. 2020 Mar 26;368:m791. doi: 10.1136/bmj.m791. PMID: 32217608; PMCID: PMC7249252.

3. Deer T, Pope J, Benyamin R, Vallejo R, Friedman A, Caraway D, Staats P, Grigsby E, Porter McRoberts W, McJunkin T, Shubin R, Vahedifar P, Tavanaiepour D, Levy R, Kapural L, Mekhail N. Prospective, Multicenter, Randomized, Double-Blinded, Partial Crossover Study to Assess the Safety and Efficacy of the Novel Neuromodulation System in the Treatment of Patients With Chronic Pain of Peripheral Nerve Origin. Neuromodulation. 2016 Jan;19(1):91-100. doi: 10.1111/ner.12381. PMID: 26799373.

Presenting Author

Raheleh Rahimi Darabad

Poster Authors

Kristopher Rogers

MD

Indiana University School of Medicine, Indianapolis, IN, USA

Lead Author

Raheleh Rahimi Darabad

MD

Indiana University School of Medicine, Indianapolis, IN, USA

Lead Author

Topics

  • Treatment/Management: Interventional Therapies – Neuromodulation