Posted on September 22, 2022
Chronic low back pain will affect over 80% of American adults at some point in their lives.
Initially, treatment for low back pain begins with rest, anti-inflammatory medications and physical therapy. For more longstanding back pain, injections or surgery may be indicated.
In many cases, back pain can persist after surgery, especially after multi-level fusion with implanted hardware.
However, after fusion surgery, there is a fairly common condition known as cluneal neuropathy, which often goes undiagnosed.
The cluneal nerves are sensory nerves that arise from the lumbar spine. These nerves give sensation to the low back and buttock areas. If they become entrapped, they can transmit pain.
Superior cluneal nerves run over the iliac crest. Middle cluneal nerves cover the sacroiliac and buttock areas.
If initial bedside diagnostic nerve blocks relieve the pain, the patient may be a candidate for Peripheral Nerve Stimulation (PNS).
The beauty of a temporary PNS trial is that it gives the patient 1 week to gauge its effectiveness. Does it improve their quality of life?
The trial involves a minor procedure to place an electrode (wire) through a needle next to the offending nerve.
This electrode is connected to an external battery device that sends electrical energy to block pain signals to the brain.
If the patient has more than 50% relief of usual pain through the trial period along with improvement in physical activity and function, a permanent implant may then be recommended.
For the permanent implant, a small device (wire or “receiver”) is implanted in the lower back through several one-inch skin incisions. The implanted receiver allows the patient to control the stimulation.
As a result, most patients experience an 80% reduction in pain along with increased function.
To discuss Peripheral Nerve Stimulation (PNS) or other treatment options to relieve pain and restore an active life, call Advanced Pain Management & Spine Specialists at 239-437- 8000 or visit: APMSS.net.