Peripheral Nerve Stimulation in Refractory Neuropathic Low Back Pain

Introduction: Spinal cord stimulation is now a treatment of pain in refractory failed back surgery syndrome. The effect on radiculalgias is quite good but often unsatisfying to treat completely low back pain. Subcutaneous peripheral nerve stimulation is now one of the possibility to rescue chronic low back pain. The aim of this prospective study conducted in our center (Nantes, France) is to evaluate the benefit of the subcutaneous peripheral nerve stimulation on chronic low back pain. Method: 34 patients (aged 44-65, mean value 54.3) with chronic bilateral low back pain were evaluated with VAS Score, Medication quantification Scale (MQS), the patient satisfaction, and walking distance before and after stimulation. Stimulation was proposed after failure of multidisciplinary management of the patient with algologist, psychologist and rehabilitation. Electrode stimulation was implanted under local or general anesthesia and a test of 7 days was performed at home. The battery was implanted only if VAS score decreased than more 50%. Mean Follow up was 6 months (range 42 to 3 months). Result: All of 34 patients were implanted with good results: VAS score decreased from 7.5 in preoperative conditions to 2.3 in postop conditions (p ≤ 0.001). 63% of patients estimated than they were very satisfy of the surgery and they could propose that to patients. The MQS decreased from 34 in preoperative to 26 two months after the surgery and to 17 6 months after surgery. Walking distance increase after the surgery (800 meters before surgery and 1700 meters after surgery). We have 1 infection and one migration of electrodes Conclusion: this series shows that subcutaneous stimulation can be benefit to treat refractory low back pain. This surgery was well tolerated, safe.