Disclosures: Mehul J. Desai, MD, MPH: SPR Therapeutics (Products/Services: Yes) (Stockholder/Ownership Interest (excluding diversified mutual funds))

Objective: The objective of this report is to demonstrate the potential use of percutaneous PNS as a motor-sparing alternative to repeat RFA and other more invasive surgical procedures in chronic LBP patients with a history of RFA in order to help guide the clinical use of percutaneous PNS.

Design: Prospective, multicenter trial Setting : Pain Management Clinic Participants : 15

Interventions: Percutaneous peripheral nerve stimulation (PNS) of the lumbar medial branch nerves for up to 60 days.

Main Outcome Measures: Average Pain Intensity (BPI-5), Oswestry Disability Index (ODI), Pain Interference (BPI-9), patient global impression of change (PGIC)

Results: Participants experienced clinically and statistically significant reductions in pain, disability and pain interference with percutaneous PNS of the lumbar medial branch nerves. After two months of PNS, the average pain intensity score was reduced from 6.3 at baseline to 2.4 (62% reduction, p < 0.0001). Highly clinically significant (≥50%) reductions in average pain intensity were reported by a majority of participants (67%, n=10/15), and a majority experienced clinically significant improvement in functional outcomes as measured by disability (87%, n=13/15, ODI, mean 21-pt reduction) and pain interference (80%, n=12/15, BPI-9) after two months. Five months after PNS, the statistically significant improvements in outcomes were sustained and a majority experienced clinically meaningful improvements in all three outcomes (i.e., pain intensity, disability, and pain interference). Conclusions: Percutaneous PNS has the potential to be an effective motor-sparing clinical alternative for the treatment of chronic axial back pain capable of providing durable non-opioid pain relief. Percutaneous PNS may also be considered for patients with axial back pain who have failed medial branch blocks, wherein RFA is not indicated and the next treatment option is often unclear. These results suggest that percutaneous PNS has the potential to shift the pain management paradigm by providing an effective, non-destructive, motor-sparing neuromodulation treatment for patients.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/motor-sparing-treatment-of-chronic-axial-back-pain-with-percutaneous-pns-of-the-medial-branch-nerves-after-return-of-pain-following-radiofrequency-ablation/