Preventing opioid prescribing for low back pain using multimodal mechanical stimulation vs. TENS: a...

Area of Science:

• Pain Management
• Neuromodulation
• Opioid Use Disorder Prevention

Background:

• Low back pain (LBP) is a leading cause for opioid prescriptions, contributing to opioid use disorder (OUD).
• Effective non-opioid LBP treatments face implementation barriers and limited insurance coverage.
• A multimodal mechanical stimulation (M-Stim) device shows promise for LBP pain reduction, but its effect on opioid use is unknown.

Purpose of the Study:

• To evaluate the impact of an M-Stim device on reducing opioid prescribing and use in patients with moderate-to-severe LBP.
• To compare the efficacy of M-Stim versus transcutaneous electrical nerve stimulation (TENS) in managing LBP and associated opioid use.
• To identify risk factors for prolonged opioid use in opioid-naïve LBP patients.

Main Methods:

• A double-blind, NIH-funded study randomized 159 patients with moderate-to-severe LBP to M-Stim or TENS devices for 30 minutes daily.
• Analgesic use was tracked daily for 28 days, with new opioid prescribing monitored weekly for 3 months.
• Primary outcome: opioid prescribing in opioid-naïve subjects; secondary outcomes: MME, use days, and comparison to national prescribing rates.

Main Results:

• Zero opioid-naïve M-Stim participants received prescriptions (0% vs. 8.6% for TENS, p=0.086).
• Opioid users on M-Stim used significantly fewer MME (7.5 vs. 498.5, p<0.0001) and reported fewer days of use (4.2% vs. 37%, p=0.0018) compared to TENS.
• M-Stim reduced MME in opioid users (-44.6%), use days for patients with BMI ≥30, and overall prescribing rates compared to national averages (-63%, p=0.002).

Conclusions:

• The M-Stim device significantly reduced opioid-related outcomes in LBP patients compared to TENS.
• M-Stim demonstrated potential as a non-opioid alternative for managing moderate-to-severe LBP, particularly in opioid-naïve individuals.
• The study highlights M-Stim's efficacy in reducing opioid use and prescribing, addressing a critical gap in LBP management.