image: The ReActive8 Implantable Neurostimulation System, manufactured by Mainstay Medical, is placed in the lower back and a pair of stimulation leads are sited on the nerve that innervates the lumbar multifidus muscle responsible for stabilizing the lower back. view more
Credit: UC San Diego Health Sciences
Advancing options for persons living with chronic back pain, UC San Diego Health has completed the first surgery in the nation to implant a device that uses neurostimulation in the form of electrical pulses to key nerves and muscles responsible for stabilizing the lower back.
"We are seeing incredible innovation in using neuromodulation to target chronic pain in a more personalized approach," said Krishnan Chakravarthy, MD, PhD, director of clinical pain research at the UC San Diego Health Center for Pain Medicine and assistant clinical professor at UC San Diego School of Medicine. "We have learned that over time patients with mechanical back pain experience degeneration of their multifidus muscle -- a series of small, triangular muscle bundles located on either side of the spinal column. By targeting this muscle with neurostimulation, we can not only reduce pain but potentially restore function."
According to the Centers for Disease Control and Prevention, one quarter of adults in the United States live with chronic back pain, an ailment that causes more global disability than any other condition.
Implanting the new device is performed in an outpatient setting, requiring no more than an hour. During the procedure, the device, roughly the size of a small pager, is placed in the lower back and a pair of stimulation leads are sited on the nerve that innervates the lumbar multifidus muscle responsible for stabilizing the lower back.
After surgery, patients receive 30 minutes of targeted neurostimulation every day twice a day, causing the multifidus muscle to contract and strengthen. The stimulation is applied through a patient-controlled remote connected to the device lead.
"We're activating these muscles by stimulating them through an electrical current, which can lead to the improvement of a person's lower back pain, but more importantly helps them rehabilitate a core stabilizer of the lower back," said Chakravarthy. "In a clinical trial for the device, a significant improvement in pain and function was observed in a majority of patients after just three months, with durable effects lasting almost four years."
According to Chakravarthy, this treatment demonstrates a paradigm shift in how pain therapies can be used and emphasizes the importance of restorative neurostimulation. Currently, most patients with chronic pain rely on medications for relief, including opioid drugs.
"Traditionally, chronic pain is managed through medication and conservative injection therapies that have their limitations," said Chakravarthy. "What we're seeing now is a positive impact through innovation by providing non-opiate pain therapy alternatives that are implantable, minimally invasive and are certainly redefining the pain management landscape by providing patients more personalized options."
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The Center for Pain Management at UC San Diego Health offers advanced pain treatment options in a compassionate and supportive environment. If you're living with chronic pain, talk with your primary care physician for options for help and treatment options.