New treatments for chronic low back pain show promise
Date: 16th March 2022 | By: Dr Lourdes Gaspar
[Journal of Neurosurgery_ Spine] Treatment of nonsurgical refractory back pain with high-frequency spinal cord stimulation at 10 kHz_ 12-month results of a pragmatic, multicenter, randomized controlled trial.pdf
Chronic low back pain is a common global problem. The point prevalence of low back pain (LBP) in 2017 was estimated to be about 7.5% of the global population, or around 577.0 million people.
The treatment options for low back pain include physiotherapy, medicine analgesia optimisation , injections and Interventional procedures and finally surgery. For patients who have had surgery and still experience ongoing severe pain there is a treatment called spinal cord stimulation. Spinal cord stimulation involves the placement of electrodes in the spinal canal in what is known as the epidural space. It is connected to a power source which is embedded in the abdominal fat and sends a continuous signal to the electrics. The production of electrical pulses within the epidural space has the effect of masking or overriding neural pain signals to the brain.
To date spinal cord stimulation for low back pain has generally been restricted to those patients who had surgery and who have predominantly associated leg pain. It is increasingly being investigated to find out whether spinal cord stimulation is useful for in patients with chronic severe low backpain have not gone for surgery. This study has evaluated the potential benefits of this treatment in this group of patients. They put patients into two groups
i) Group A received spinal cord stimulation + conventional medication management
ii) Group B add conventional medication management. After six months those in Group B (who were thought to be suitable) also had spinal cord stimulation. The results at 6 month showed – Group A achieved significant reduction in pain and improved overall function compared to Group B
The results at 12 months showed – Group B and Group A were achieving similar results.
The overall reduction in pain was reports as being approximately 72% in 80% of patients at 12 months.
These results represent hope that new treatments may come to the mainstream for people living daily chronic low back pain.
An average reported reduction of 72 % of pain means that patient’s having this treatment should not consider that this as a “light switch treatment”. Living with 28% of the original pain is still likely to have an intrusive impact on daily life and on mood and psychological well-being
Furthermore, 20% of patients continued to experience greater than 50% of their original pain.. These people will require ongoing support to do with the psychological impact of pain.
We believe there is a need for a program such as ours even when advanced treatments such as those featured in this study are applied to chronic low back pain to help patients to lead a more fulfilling life.