Review

. 2025 Mar 14:18:1247-1274.

doi: 10.2147/JPR.S500342. eCollection 2025.

An Evidence-Based Consensus for the Use of Neurostimulation for the Treatment of Non-Surgical Low Back Pain: The NEURON Group

Timothy Ray Deer¹, Jason E Pope², Erika A Petersen³, Rany T Abdallah⁴, Kasra Amirdelfan⁵, Nomen Azeem⁶, Vishal Bansal⁷, Kaku Barkoh⁸, Kenneth B Chapman^{9

10}, Daniel R Denis¹¹, Michael J Dorsi¹², Alexander Escobar¹³, Steven Michael Falowski¹⁴, Rosa Amelia Garcia¹⁵, Jonathan M Hagedorn¹⁶, Robert D Heros¹⁷, Whitney S James¹⁸, Hemant Kalia¹⁹, Todd Lansford²⁰, Mark N Malinowski²¹, Suzanne Marie Manzi²², Pankaj Mehta²³, Robert Z Moghim²⁴, Gregory Anthony Moore²⁵, Soriaya Lizette Motivala²⁶, Yeshvant A Navalgund²⁷, Raj G Patel²⁸, Julie G Pilitsis²⁹, Michael E Schatman^{30

31}, Philip Michael Shumsky³², Natalie Holmes Strand³³, Nestor D Tomycz³⁴, James J Yue³⁵, Dawood Sayed³⁶

Affiliations

¹ Pain Services, Spine and Nerve Center of the Virginias, Charleston, WV, USA.
² Evolve Restorative Center, Santa Rosa, CA, USA.
³ Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
⁴ Pain Management, Apico Pain Management, Bear, DE, USA.
⁵ Director of Clinical Research, Boomerang Healthcare, Walnut Creek, CA, USA.
⁶ Pain Medicine, Florida Spine & Pain Specialists, Riverview, FL, USA.
⁷ Department of Pain Medicine, the University of Texas MD Anderson Cancer Center, Houston, TX, USA.
⁸ Orthopaedic Associates, Houston, TX, USA.
⁹ Department of Anesthesiology, NYU Langone Medical Center, New York, NY, USA.
¹⁰ Department of Anesthesiology, the Zucker School of Medicine at Northwell, New York, NY, USA.
¹¹ Neurosurgery, Ochsner Health, New Orleans, LA, USA.
¹² Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA.
¹³ Anesthesiology and Pain Medicine, University of Toledo, Toledo, OH, USA.
¹⁴ Neurosurgery, Neurosurgical Associates of Lancaster, Lancaster, PA, USA.
¹⁵ Department of Pain Medicine, University of Florida, Gainsville, FL, USA.
¹⁶ Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
¹⁷ Spinal Diagnostics, Tualatin, OR, USA.
¹⁸ Neurosurgery, James-Marco Health, Prescott, AZ, USA.
¹⁹ Center for Research & Innovation in Spine & Pain (CRISP), Rochester, NY, USA.
²⁰ South Carolina Sports Medicine, Charleston, SC, USA.
²¹ OhioHealth Neurological Physicians, OhioHealth, Columbus, OH, USA.
²² Physician Co-Owner, Performance Pain and Sports Medicine, Houston, TX, USA.
²³ Division of Pain and Minimally Invasive Surgery, Pain Specialists of America, Austin, TX, USA.
²⁴ Interventional Spine and Pain, Colorado Pain Care, Denver, CO, USA.
²⁵ Pacific Sports and Spine, Eugene, OR, USA.
²⁶ Department of Neurosurgery, Northwell Health, New York, NY, USA.
²⁷ Office of the Chief Medical Officer, National Spine and Pain Centers, Frederick, MD, USA.
²⁸ Interventional Pain Management, Capitol Pain Institute, Austin, TX, USA.
²⁹ Department of Clinical Neurosciences, Florida Atlantic University, Boca Raton, FL, USA.
³⁰ Department of Anesthesiology, Perioperative Care & Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA.
³¹ Department of Population Health - Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USA.
³² Anesthesiology and Pain Medicine, Evolve Restorative Center, Santa Rosa, CA, USA.
³³ Anesthesiology and Pain Medicine, Mayo Clinic, Phoenix, AZ, USA.
³⁴ Neurological Surgery, Allegheny Health Network, Pittsburgh, PA, USA.
³⁵ Frank h Netter School of Medicine, Quinnipiac University; CT Orthopaedics, Hamden, CT, USA.
³⁶ Anesthesiology and Pain Medicine, the University of Kansas Medical Center, Kansas City, KS, USA.

PMID: 40104824
PMCID: PMC11917438
DOI: 10.2147/JPR.S500342

Review

An Evidence-Based Consensus for the Use of Neurostimulation for the Treatment of Non-Surgical Low Back Pain: The NEURON Group

Timothy Ray Deer et al. J Pain Res. 2025.

. 2025 Mar 14:18:1247-1274.

doi: 10.2147/JPR.S500342. eCollection 2025.

Authors

Affiliations

¹ Pain Services, Spine and Nerve Center of the Virginias, Charleston, WV, USA.
² Evolve Restorative Center, Santa Rosa, CA, USA.
³ Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
⁴ Pain Management, Apico Pain Management, Bear, DE, USA.
⁵ Director of Clinical Research, Boomerang Healthcare, Walnut Creek, CA, USA.
⁶ Pain Medicine, Florida Spine & Pain Specialists, Riverview, FL, USA.
⁷ Department of Pain Medicine, the University of Texas MD Anderson Cancer Center, Houston, TX, USA.
⁸ Orthopaedic Associates, Houston, TX, USA.
⁹ Department of Anesthesiology, NYU Langone Medical Center, New York, NY, USA.
¹⁰ Department of Anesthesiology, the Zucker School of Medicine at Northwell, New York, NY, USA.
¹¹ Neurosurgery, Ochsner Health, New Orleans, LA, USA.
¹² Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA.
¹³ Anesthesiology and Pain Medicine, University of Toledo, Toledo, OH, USA.
¹⁴ Neurosurgery, Neurosurgical Associates of Lancaster, Lancaster, PA, USA.
¹⁵ Department of Pain Medicine, University of Florida, Gainsville, FL, USA.
¹⁶ Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
¹⁷ Spinal Diagnostics, Tualatin, OR, USA.
¹⁸ Neurosurgery, James-Marco Health, Prescott, AZ, USA.
¹⁹ Center for Research & Innovation in Spine & Pain (CRISP), Rochester, NY, USA.
²⁰ South Carolina Sports Medicine, Charleston, SC, USA.
²¹ OhioHealth Neurological Physicians, OhioHealth, Columbus, OH, USA.
²² Physician Co-Owner, Performance Pain and Sports Medicine, Houston, TX, USA.
²³ Division of Pain and Minimally Invasive Surgery, Pain Specialists of America, Austin, TX, USA.
²⁴ Interventional Spine and Pain, Colorado Pain Care, Denver, CO, USA.
²⁵ Pacific Sports and Spine, Eugene, OR, USA.
²⁶ Department of Neurosurgery, Northwell Health, New York, NY, USA.
²⁷ Office of the Chief Medical Officer, National Spine and Pain Centers, Frederick, MD, USA.
²⁸ Interventional Pain Management, Capitol Pain Institute, Austin, TX, USA.
²⁹ Department of Clinical Neurosciences, Florida Atlantic University, Boca Raton, FL, USA.
³⁰ Department of Anesthesiology, Perioperative Care & Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA.
³¹ Department of Population Health - Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USA.
³² Anesthesiology and Pain Medicine, Evolve Restorative Center, Santa Rosa, CA, USA.
³³ Anesthesiology and Pain Medicine, Mayo Clinic, Phoenix, AZ, USA.
³⁴ Neurological Surgery, Allegheny Health Network, Pittsburgh, PA, USA.
³⁵ Frank h Netter School of Medicine, Quinnipiac University; CT Orthopaedics, Hamden, CT, USA.
³⁶ Anesthesiology and Pain Medicine, the University of Kansas Medical Center, Kansas City, KS, USA.

PMID: 40104824
PMCID: PMC11917438
DOI: 10.2147/JPR.S500342

Abstract

Introduction: The use of electrical neuromodulation has often been limited to those with previous back surgery, peripheral neuropathy, and complex regional pain syndrome. Many patients with severe intractable low back pain were thought to be candidates for spinal cord stimulation (SCS), dorsal root ganglion stimulation, or peripheral nerve stimulation but did not meet the criteria. Recently, additional high-level data has supported the use of SCS in non-surgical low back pain (NSLBP), and United States Food and Drug Administration approval has been granted. The American Society of Pain and Neuroscience (ASPN) executive committee realized an unmet need to develop criteria for patient selection for this specific patient population. This is a NEURON project (neuroscience, education, utilization, risk mitigation, optimal outcomes, and neuromodulation), a living guideline for evolving therapies and indications, and is focused on the use of neuraxial stimulation for the treatment of refractory pain.

Methods: After board approval, the society accepted nominees for the project, with an emphasis on experience, publication, research, and diversity. The team created an outline for discussion, chose a grading system based on published guidelines, and created consensus points.

Results: The evidence led to several consensus points to best guide patient selection based on the level of evidence and expert opinion. The results will lead to improved safety and efficacy in implanted patients, and to a new standard for best practices.

Conclusion: The selection of patients for implantation in those who have NSLBP should be based on published literature, best practice, and expert opinion. This NEURON project will allow for regular updates to create a living guideline that will allow for better assimilation of information to improve safety and efficacy going forward.

Keywords: DRG; DRG-S; NSLBP; PNS; SCS; dorsal root ganglion stimulation; failed back surgery syndrome; low back pain; lumbar degenerative disc disease; non-surgical back; non-surgical low back pain; peripheral nerve stimulation; spinal cord stimulation.

PubMed Disclaimer

Conflict of interest statement

TRD is a consultant for Abbott, Vertos, SpineThera, Saluda Medical, Cornerloc, SPR Therapeutics, Boston Scientific, PainTEQ, Spinal Simplicity, and Biotronik; an advisory board member for Abbott, Vertos, SPR Therapeutics, and Biotronik; has a pending patent with Abbott; and has received research funding from Abbott, Vertos, Saluda, Mainstay, SPR Therapeutic, Boston Scientific, and PainTEQ. JEP is a consultant for Abbott, Medtronic, Saluda, Flowonix, SpineThera, PainTEQ, Vertos, Vertiflex, SPR Therapeutics, Tersera, Aurora, Spark, Ethos, Flowonix, Biotronik, Mainstay, WISE, Boston Scientific, Thermaquil, and SpineThera; has received grant/research support from Abbott, Flowonix, Saluda, Aurora, PainTEQ, Ethos, Muse, Boston Scientific, SPR Therapeutics, Mainstay, Vertos, AIS, and Thermaquil; and is a shareholder for Vertos, SPR Therapeutics, PainTEQ, Aurora, Spark, Celeri Health, Neural Integrative Solutions, Pacific Research Institute, Thermaquil, Saluda, Abbott, SpineThera, and Axonics. EAP has received research support from Mainstay, Medtronic, Nalu, Neuros Medical, Nevro Corp, ReNeuron, SPR, and Saluda, as well as personal fees from Abbott Neuromodulation, Biotronik, Medtronic Neuromodulation, Nalu, Neuros Medical, Nevro, Presidio Medical, Saluda, and Vertos; and holds stock options from SynerFuse and neuro42. KA is a consultant for Nevro, Saluda, Biotronik, Boston Scientific, and Presidio. NA is a speaker for PainTEQ, Vivex, Medtronic, Spinal Simplicity, and Vertos; serves on advisory boards for PainTEQ, Vivex, Medtronic, Spinal Simplicity, and Vertos; has received research funding from PainTEQ, Vivex, Medtronic, and Spinal Simplicity; has received grants from PainTEQ, Vivex, and Spinal Simplicity; and holds stock in Spinal Simplicity. KB is a consultant for Abbott and Degen Medical; and serves on advisory boards for XoBiologix and Spinal Simplicity. KBC receives research funding from Abbott. DRD is a consultant for Abbott, Johnson & Johnson, Globus Medical, SI-Bone, and receives royalties from Globus Medical. MJD is a consultant for Globus, Camber, LifeSpine, Vyrsa, PainTEQ, Nevro, Abbott, and Biotronik. AE is a consultant for Medtronic, Nevro, Stryker, and Vertos Medical. SMF is a consultant to Abbott, Medtronic, Saluda, Vertos, CornerLoc, and Mainstay; has equity in Backstop Neural, SurgenTec, SynerFuse, Aurora Spine, Thermaquil, SPR Therapeutics, Saluda, CornerLoc, PainTeq, SpineThera, and Celeri; and has research agreements with Aurora, Mainstay, Medtronic, Abbott, Vertiflex, Saluda, CornerLoc, and Biotronik. RDH is a consultant for Mainstay Medical, Abbott, Saluda, and Biotronik; a speaker for Mainstay Medical and Saluda; and has received research funding from Mainstay Medical, Abbott, Saluda, and Ethos Laboratories. HK is a consultant for Abbott and Nalu, and a speaker for Averitas Pharma. TL is a consultant for Abbott and Alpha Tec, and receives royalties from Alpha Tec. MNM has consulting agreements with Abbott, Nalu Medical, BiotronikNEURO, and SI Bone Inc.; and serves on the scientific advisory board of BiotronikNEURO. SMM is a consultant for Biotronik, Stratus Medical, Curonix, Medtronic, and Boston Scientific. RZM is a consultant for Saluda, Genesys Spine, Vertos, Curonix, Abbott, and PainTEQ. GAM receives research funding from Abbott, Boston Scientific, Nalu, and Mainstay Medical, and is a consultant for Abbott, Boston Scientific, Relievant, and Aurora. SM is a faculty/advisor for Medtronic, Boston Scientific, Nevro and Abbott. YAN is a consultant for Abbott Neuromodulation. RGP is a consultant for Abbott. JGP receives grant support from Medtronic, Boston Scientific, Abbott, Focused Ultrasound Foundation and the NIH (2R01CA166379, R01EB030324, R18EB036591, 5U54EB033650 and U44NS115111), is the medical advisor for Aim Medical Robotics and has stock equity. MES is a Senior Medical Advisor for Apurano Pharma (outside of the scope of this work) and is editor-in-chief of the Journal of Pain Research. PS is a consultant for Saluda. NDT is a consultant for Abbott Medical and SI Bone, and serves on an advisory board for Boston Scientific. JJY is a consultant for Abbott and Saluda. DS is a consultant to Abbott, PainTEQ, Saluda, Mainstay, Surgentec, and Nevro and holds stock options with PainTEQ, Neuralace, Mainstay, and Vertos. The authors report no other conflicts of interest in this work.

References

1. Kapural L, Jameson J, Johnson C. et al. Treatment of nonsurgical refractory back pain with high-frequency spinal cord stimulation at 10 kHz: 12-month results of a pragmatic, multicenter, randomized controlled trial. J Neurosurg Spine. 2022;37(2):188–199. doi:10.3171/2021.12.SPINE211301 - DOI - PubMed
1. Patel N, Calodney A, Kapural L, et al. High-Frequency Spinal Cord Stimulation at 10 kHz for the Treatment of Nonsurgical Refractory Back Pain: design of a Pragmatic, Multicenter, Randomized Controlled Trial. Pain Pract. 2021;21(2):171–183. doi:10.1111/papr.12945 - DOI - PMC - PubMed
1. Stevans JM, Delitto A, Khoja SS, et al. Risk Factors Associated With Transition From Acute to Chronic Low Back Pain in US Patients Seeking Primary Care. JAMA Network Open. 2021;4(2):e2037371. doi:10.1001/jamanetworkopen.2020.37371 - DOI - PMC - PubMed
1. Chou R, Shekelle P. Will this patient develop persistent disabling low back pain? JAMA. 2010;303(13):1295–1302. doi:10.1001/jama.2010.344 - DOI - PubMed
1. Patrick N, Emanski E, Knaub MA. Acute and chronic low back pain. Med Clin North Am. 2014;98(4):777–789. doi:10.1016/j.mcna.2014.03.005. - DOI - PubMed

Publication types

Actions

LinkOut - more resources

Full Text Sources
- Dove Medical Press
- PubMed Central

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

An Evidence-Based Consensus for the Use of Neurostimulation for the Treatment of Non-Surgical Low Back Pain: The NEURON Group

Affiliations

An Evidence-Based Consensus for the Use of Neurostimulation for the Treatment of Non-Surgical Low Back Pain: The NEURON Group

Authors

Affiliations

Abstract

Conflict of interest statement

Similar articles

References

Publication types

LinkOut - more resources

Full Text Sources

Abstract

Conflict of interest statement

Similar articles

References

Publication types

Related information

LinkOut - more resources

Full Text Sources