{"id":40672,"date":"2021-07-20T16:01:01","date_gmt":"2021-07-20T22:01:01","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=40672"},"modified":"2024-08-05T13:17:13","modified_gmt":"2024-08-05T19:17:13","slug":"lower-back-pain-now-treated-by-implantable-nerve-stimulation-device","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/lower-back-pain-now-treated-by-implantable-nerve-stimulation-device\/","title":{"rendered":"Lower back pain now treated by implantable nerve stimulation device"},"content":{"rendered":"
<\/div>

Daniel Montoya was a young man living in New Mexico when he went to the oilfields to make a living doing what he describes today as \u201cback-breaking work.\u201d In the early 1990s he departed the state for Colorado, where he began a new career in law enforcement.<\/p>\n

Montoya, now 49, has been a parole officer for the State of Colorado for the past 15 years. His days as an oil hand in New Mexico are far behind him, but for many years he has had an unwelcome memory of his youthful work: persistent lower back pain.<\/p>\n

\u201cIt was always there,\u201d Montoya said. \u201cI got used to it, but some days were much worse than others. I would lie or sit in a certain position for a while and then I couldn\u2019t stand up.\u201d<\/p>\n

\"Chronic
Chronic low back pain that can\u2019t be treated with surgery is a common problem. Photo: Getty Images.<\/figcaption><\/figure>\n

Montoya tried to treat the pain with physical therapy and medications \u2013 which he disliked taking \u2013 but couldn\u2019t find relief. Nor did he have a clear problem, like a compressed nerve, that could be corrected with surgery. So for many years he lived with the discomfort, even as it put a damper on activities like water sports and playing with his son, who is now 12.<\/p>\n

Lower back pain and a possible solution<\/strong><\/h2>\n

It\u2019s a common dilemma for many people, said Dr. Vikas Patel<\/a>, a spine surgery specialist and professor with the Department of Orthopedics<\/a> at the University of Colorado School of Medicine<\/a>. Patel said he sees large numbers of patients with chronic back pain at the UCHealth Spine Center \u2013 Anschutz Medical Campus<\/a>, but he can\u2019t give them all straightforward solutions for their problems.<\/p>\n

\"UCHealth
UCHealth spine surgeon Dr. Vikas Patel, led the ReActiv8 trial for the CU Department of Orthopedics. Photo courtesy of UCHealth.<\/figcaption><\/figure>\n

\u201cSome patients have a clear pathology, with a clear source of pain and a clear indicator for surgery \u2013 like a herniated disc,\u201d Patel said. \u201cBut we also have a large group of non-surgical patients with back pain that doesn\u2019t get better with treatments like physical therapy. We\u2019ve had no great answer for those patients.\u201d<\/p>\n

That could change with the successful completion of a multi-site clinical trial<\/a> of a new device designed to help patients like Daniel Montoya. The ReActiv8 Implantable Neurostimulation System, approved by the FDA last summer, uses electrical signals to rehabilitate and strengthen the weakened deep lower-back muscles, called the multifidus, that lie beside the spine. The idea: stronger muscles help to lessen pain.<\/p>\n

\u201cWe\u2019ve seen pretty dramatic improvements,\u201d said Patel, who was principal investigator for the CU Department of Orthopedics trial site. \u201cIt\u2019s been nice to see how patients have recovered and had a gradual reduction in their symptoms.\u201d Patel said the hospital in mid-May approved offering the device to new patients.<\/p>\n

Electrical signals stimulate muscles<\/strong><\/h2>\n

How does it work? Patel said patients require an outpatient surgery, during which he first implants leads next to the dorsal ramus nerves outside the spinal canal. These nerves feed the lower-back muscles. The leads connect to a battery pack and minicomputer that Patel implants in the patient\u2019s side with a second incision. Patients use a remote control to turn on this device, which signals the nerves to fire and stimulate the muscles, prodding them to rebuild. Think of it as rehabilitation with a remote control.<\/p>\n

In the trial, patients in the study group used the device for two 30-minute sessions, once before bed and once before getting up, for 120 days. A control group received a lower stimulation dose for the 120-day period, then transitioned to the full dose. The patients also kept pain journals and returned for check-ups at 180, 240 and 365 days and now do so annually.<\/p>\n

Assessments of their pain<\/a> and their function<\/a> each showed meaningful improvements, according to the FDA and to study results presented in an article co-authored by Patel and published in March in the journal Pain<\/em><\/a>. Nearly half of the patients also reduced or eliminated their use of opioids to manage their pain. Those in the trial now use the stimulation on an as-needed basis.<\/p>\n

A nerve stimulator, not a scrambler<\/strong><\/h2>\n
\"The
The ReActiv8 device uses implanted leads and a battery pack to supply nerve stimulation that helps to alleviate chronic back pain. Image courtesy of Mainstay Medical.<\/figcaption><\/figure>\n

Patel said ReActiv8 also offers an alternative to spinal cord stimulation<\/a>, which uses electrodes implanted on top of the spinal cord that are attached to a battery pack. When the device fires, it scrambles the pain signals the spine sends to the brain. That can be effective, but the approach doesn\u2019t address the problem of muscles weakened by years of chronic pain.<\/p>\n

\u201cIn some ways, that\u2019s a Band-Aid we\u2019ve used to block sensation,\u201d Patel said. \u201cReActiv8 uses muscle-building stimulation versus entry-signal scrambling.\u201d<\/p>\n

Welcome relief for chronic pain<\/strong><\/h2>\n

Whatever the mechanisms, Daniel Montoya said he found relief with the ReActiv8 device. He discovered the trial about three years ago in a Facebook post, contacted Patel\u2019s team for more information and qualified for enrollment. The first 120 days were a bit of a challenge, partly because it was difficult to stick to the treatment schedule. He also had to get used to the sensations he felt when the device stimulated his lower-back muscles.<\/p>\n

\u201cAt first it felt like an elephant stepping on my lower back,\u201d he said. \u201cI could feel the pressure going on and off.\u201d But the pain gradually lessened, and he soon learned to use the stimulation only when he needed it. If he\u2019s had a tough day, for example, he uses it before bed.<\/p>\n

\u201cWhen I get up the next morning, I\u2019m fine,\u201d he said.<\/p>\n

As for the long years of chronic pain, Montoya said he believes they are behind him, and he credits ReActiv8.<\/p>\n

\u201cRight now, I have no back pain,\u201d he said. \u201cIt\u2019s not a concern for me. The pain relief I get is immediate. It\u2019s like having a therapist [massaging] right on your spine or disc.\u201d<\/p>\n

Patel said he envisions more people like Montoya who are not candidates for surgery gaining relief from the device for their chronic lower-back pain.<\/p>\n

\u201cIt could be used on a daily, routine basis, like exercise,\u201d he said. \u201cIt\u2019s easy to see how hundreds of patients might benefit from it.\u201d<\/p>\n

For more information about the ReActivat8 device, contact the UCHealth Spine Center at 720.848.1980.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

Daniel Montoya was a young man living in New Mexico when he went to the oilfields to make a living doing what he describes today as \u201cback-breaking work.\u201d In the early 1990s he departed the state for Colorado, where he began a new career in law enforcement. Montoya, now 49, has been a parole officer […]<\/p>\n","protected":false},"author":2143,"featured_media":40675,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[5],"tags":[708,574,183,9171,9167],"class_list":["post-40672","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-innovative-care","tag-adults-65-plus","tag-back-neck-and-spine-care","tag-orthopedics","tag-senior-care","tag-specialized-services"],"acf":[],"yoast_head":"\nLower back pain now treated by implantable nerve stimulation device - 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