title: Chronic Low Back Pain: Restoration of Dynamic Stability.
abstract: OBJECTIVE
  Electrical stimulation for multifidus muscle contraction is a novel approach for treating chronic low back pain (CLBP). A multicenter, open-label feasibility study investigated this modality in patients with continuing CLBP despite medical management and no prior back surgery and no known pathological cause of CLBP.
  
  
  METHODS
  Twenty-six patients with continuing CLBP despite physical therapy and medication were implanted with commercially-available implantable pulse generators and leads positioned adjacent to the medial branch of the dorsal ramus as it crosses the L3 transverse process such that electrical stimulation resulted in contraction of the lumbar multifidus (LM) muscle. Patients self-administered stimulation twice daily for 20 min. Low back pain (VAS), Oswestry Disability Index (ODI) and Quality of Life (EQ-5D) scores were collected at three and five months and compared to baseline. Stimulation was withdrawn between months 4 and 5 to test durability of effect.
  
  
  RESULTS
  At three months, 74% of patients met or exceeded the minimally important change (MIC) in VAS and 63% for disability. QoL improved in 84% of patients (N = 19) and none got worse. Five of the 11 patients on disability for CLBP (45%) resumed work by three months. Half the patients reported ≥50% VAS reduction by month 5. Twenty-one lead migration events occurred in 13 patients, of which 7 patients are included in the efficacy cohort.
  
  
  CONCLUSIONS
  Episodic stimulation to induce LM contraction can reduce CLBP and disability, improve quality of life and enable return to work. A dedicated lead design to reduce risk of migration is required.
authors: Department of Physical Medicine and Rehabilitation, GZA Hospitals, Antwerpen, Belgium.
authors: Kristiaan
authors: K
authors: Deckers
authors: Department of Neurosurgery, GZA Hospitals, Antwerpen, Belgium.
authors: Kris
authors: K
authors: De Smedt
authors: Multidisciplinary Pain Centre, AZ Nikolaas, Sint Niklaas, Belgium.
authors: Jean-Pierre
authors: JP
authors: van Buyten
authors: Multidisciplinary Pain Centre, AZ Nikolaas, Sint Niklaas, Belgium.
authors: Iris
authors: I
authors: Smet
authors: Department of Pain and Anaesthesia, The James Cook University Hospital, Middlesbrough, UK.
authors: Sam
authors: S
authors: Eldabe
authors: Department of Pain and Anaesthesia, The James Cook University Hospital, Middlesbrough, UK.
authors: Ashish
authors: A
authors: Gulve
authors: Leeds Pain and Neuromodulation Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors: Ganesan
authors: G
authors: Baranidharan
authors: Anesthesia Critical Care and Pain Management, General University Hospital, Valencia, Spain.
authors: José
authors: J
authors: de Andrès
authors: Massachusetts General Hospital, Center for Pain Medicine, Boston, USA.
authors: Chris
authors: C
authors: Gilligan
authors: Mainstay Medical Limited, Swords, Ireland.
authors: Kristen
authors: K
authors: Jaax
authors: Mainstay Medical Limited, Swords, Ireland.
authors: Jan Pieter
authors: JP
authors: Heemels
authors: Mainstay Medical Limited, Swords, Ireland.
authors: Peter
authors: P
authors: Crosby
mesh_terms: D000328:Adult; D002908:Chronic Disease; D004185:Disability Evaluation; D006233:Persons with Disabilities; D004599:Electric Stimulation Therapy / Q000295:instrumentation / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000503:physiopathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000209:etiology / Q000628:therapy; D017711:Nonlinear Dynamics; D010147:Pain Measurement; D020127:Recovery of Function / Q000502:physiology*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Low back pain; motor control; multifidus; quality of life; stimulation