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Research showed that nearly two-thirds of patients sustained clinically meaningful relief over 4 years after a 60-day PNS treatment for chronic low back pain.

More than four years after undergoing short-term percutaneous peripheral nerve stimulation for chronic low back pain, nearly two-thirds of trial participants reported ongoing clinically meaningful pain relief, according to a follow-up study published online ahead of print in Pain Therapy.

“Chronic low back pain (LBP) is a leading cause of healthcare expenditure and long-term disability associated with complex treatment challenges and the need for progressively invasive interventions,” wrote corresponding author Christopher A. Gilmore, MD, of the Carolinas Pain Institute, and study coauthors.

Percutaneous 60-day peripheral nerve stimulation (PNS), a minimally invasive neurostimulation treatment, has shown efficacy for chronic LBP, providing sustained improvements through 1 year of follow-up after treatment, according to the authors.

“These results demonstrate that percutaneous 60-day PNS can provide durable outcomes that are sustained for multiple (4+) years in some patients with chronic axial LBP [lower back pain], which may mitigate the need for more invasive treatment interventions.”

Long-Term Results Build on Initial Study Findings

The original prospective trial showed that most patients with chronic lower back pain experienced significant reductions in pain intensity, disability, and/or pain interference 12 months after undergoing percutaneous 60-day PNS targeting the medial branches. For this study, researchers sent follow-up surveys to the 37 patients who benefited from the treatment in the first study; 23 patients completed the long-term follow-up questionnaires.

The study showed that among these respondents, 15 patients (65%) reported continued clinically meaningful lower back pain relief when compared to their pretreatment levels, with an average follow-up duration of 4.7 years. Clinically meaningful relief was defined as a reduction in pain of 30% or more.

Substantial Improvements in Pain & Function

The average pain reduction among long-term responders reached 63%, exceeding the 50% threshold for clinically substantial improvement. These patients also reported sustained improvements in function and QOL, according to the study findings. Disability, as measured by the Oswestry Disability Index, decreased by an average of 11.5 points. In terms of QOL, average Patient Global Impression of Change scores fell between “minimally improved” and “much improved.”

Avoiding Invasive Interventions

Importantly, 16 of the 23 respondents (70%) avoided progressing to more costly, invasive, and/or destructive pain interventions over the follow-up period, such as radiofrequency ablation (RFA), neurostimulation implants, or lumbar surgery. The most commonly used pharmacologic treatments for back pain were nonopioid analgesics such as nonsteroidal anti-inflammatory drugs. Six patients reported using opioids.

“Given that a majority of surveyed participants (70%) avoided use of RFA, neurostimulation implant, or lumbar surgery during long-term follow-up, incorporating percutaneous 60-day PNS earlier into the treatment continuum for chronic axial LBP may preclude or reduce the need for more destructive or invasive procedures,” the researchers concluded, “potentially leading to reduced health care costs and improved patient outcomes.”