Restorative Neurostimulation for Patients with Mechanical Chronic Low Back Pain and Impaired Neuromuscular Control of the Lumbar Spine | A New Treatment Paradigm.

Chronic low back pain (CLBP) is a symptom of an underlying pathology. There are distinct phenotypes of CLBP, including neuropathic, nociplastic and nociceptive, or mechanical CLBP. We present a comprehensive clinical overview of restorative neurostimulation for refractory, disabling, mechanical CLBP. Impaired neuromuscular control and consequent degeneration of the multifidus muscles are implicated in the development and persistence of mechanical low back pain. Restorative neurostimulation targets these processes and aims to reverse these degenerative changes in the muscles and mechanoreceptor in the muscle spindles and, therefore, restore motor control of the multifidus muscles, playing an important role for functional stability of the lumbar spine. We detail the theory and rationale of the technology as well as appropriate patient identification and current trial evidence in this comprehensive overview of restorative neurostimulation.