Restorative Neurostimulation Outcomes for Mechanical Chronic Low Back Pain: Delayed-Start Crossover from Optimal...

Area of Science:

• Neuromuscular control
• Musculoskeletal disorders
• Pain management

Background:

• Chronic low back pain (CLBP) linked to lumbar multifidus dysfunction causes significant disability.
• Current treatments offer limited and temporary relief.
• Restorative neurostimulation aims to restore neuromuscular control by activating the lumbar multifidus.

Purpose of the Study:

• To evaluate long-term outcomes of restorative neurostimulation in a crossover group.
• To extend follow-up for participants in the original treatment group for an additional year.

Main Methods:

• A multicenter, open-label randomized controlled trial (RCT) involving 203 participants.
• Participants were randomized to restorative neurostimulation or optimal medical management.
• A crossover design allowed control participants to receive treatment, with follow-up at 18 and 24 months.

Main Results:

• Sustained improvements in Oswestry Disability Index (ODI), pain (NRS), and quality of life (EQ-5D-5L) were observed in the treatment group through 24 months.
• Participants who crossed over showed significant improvements comparable to the original treatment group.
• High responder rates for pain reduction and functional improvement were achieved, with a low number needed to treat.

Conclusions:

• Restorative neurostimulation is an effective treatment for multifidus dysfunction-related CLBP in patients refractory to conservative care.
• Earlier intervention may prevent prolonged disability and enhance quality of life.