Spinal Cord Stimulation for Chronic Non Surgical Low Back Pain: Fact or Fiction?

Session Title: Spinal Cord Stimulation for Chronic Non Surgical Low Back Pain: Fact or Fiction?

Topic: CLINICAL SCIENCE

Description: Three randomised controlled trials have compared Spinal Cord Stimulation (SCS) to conventional medical management (CMM) for the treatment of non-surgical low back pain. Apart from the presence of chronic moderate to severe low back pain with no surgical solution, the only other positive selection criterion proposed was the presence of a neuropathic component of the low back pain. The workshop will explore the condition of chronic refractory low back pain and consider what is known about back pain sub-groups grounded in biophysical, social and psychological factors. Then investigate the term 'neuropathic low back pain' before going on to discuss the evidence for the effectiveness of SCS as a treatment option for refractory low back pain and outline the strengths and limitations of the studies examining the issue.

The workshop addresses the role of neuromodulation in the treatment of Non specific low back pain (NSLBP)
the proposal consists of a starting focus on the nature and aetiologies of low back pain and a focus on the lessons learnt from research on NSLBP and applicability of such learnings to the area of neuromodulation

Followed by an in depth examination of the accumulating evidence of neuromodulation NSLBP

Chair: Sam Eldabe (UK)

Speaker 1:

What is low back pain, and what are the learnings from Researching low back pain

Martin Underwood will explore the term non-specific low back pain NSLBP and consider what is known about subgroups of NSLBP. The talk will then move to explain some of the learnings from researching low back pain over the years.

Speaker 2:

Eric Buschser will present the case against the use of SCS in NSRBP outlining the limitations of the available evidence as well as the potential impact on healthcare systems. He will explore the term neuropathic low back pain and its scientific validity as a biomarker for response to SCS.

Speaker 3:

Chris Gilligan will present the accumulating evidence of the effectiveness and cost-effectiveness of SCS in NSRBP. He will present the RCTs that have reported evidence of effectiveness of the therapy .He will also outline his work on multifidus muscle stimulation for the treatment of back pain with specific muscular component contrasting the selection criteria for various NSLBP studies in neuromodulation

S Eldabe is the Neuromodulation SIG chair will chair the symposium

Speakers

Martin Underwood University of Warwick
United Kingdom

Professor Underwood has worked as a general (family) practitioner in Lusaka (Zambia) , Manchester, London's East End, and latterly in Coventry. He is now based in Warwick Clinical Trials Unit where his focus is on clinical trial methodology. He has a substantial and diverse portfolio of completed randomised controlled trials and systematic reviews. Recently completed studies include trials of robotic assisted knee replacement and of remote multicomponent rehabilitation in intensive care unit survivors. His main areas of current clinical research interests are in the community management of chronic painful disorders and randomised controlled trials of orthopaedic surgery. He was co-chair of the Guideline Development Group for the WHO guideline for the community management of chronic low back pain.

Eellan Sivanesan Johns Hopkins University - School of Medicine
United States

Dr. Eellan Sivanesan is an Associate Professor of Anesthesiology and Critical Care Medicine at the Johns Hopkins University School of Medicine, where he serves as Director of the Blaustein Pain Treatment Center and Director of Neuromodulation in the Division of Pain Medicine. He is a clinician-scientist and chronic pain specialist with a comprehensive practice spanning medical, interventional, and multidisciplinary care of complex pain conditions.

His clinical and research focus centers on neuromodulation, particularly spinal cord stimulation, as a tool to understand and treat chronic neuropathic pain through immune and molecular mechanisms. His work integrates preclinical models and translational studies in chemotherapy-induced peripheral neuropathy and cancer-related pain, bridging mechanistic research and clinical care. He contributes to national and international efforts that shape standards and best practices in pain medicine and neuromodulation.

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