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Review
. 2025 Nov 4:18:5799-5813.
doi: 10.2147/JPR.S525057. eCollection 2025.

Restorative Neurostimulation for Patients with Mechanical Chronic Low Back Pain and Impaired Neuromuscular Control of the Lumbar Spine | A New Treatment Paradigm

Christopher J Gilligan  1 , Avinash S Chavda  2 , Johnson S Ho  3 , David W Lee  4 , Meredith Langhorst  5 , Erika T Yih  6 , Marco Amann  7
Affiliations
Review

Restorative Neurostimulation for Patients with Mechanical Chronic Low Back Pain and Impaired Neuromuscular Control of the Lumbar Spine | A New Treatment Paradigm

Christopher J Gilligan et al. J Pain Res. .

Abstract

Chronic low back pain (CLBP) is a symptom of an underlying pathology. There are distinct phenotypes of CLBP, including neuropathic, nociplastic and nociceptive, or mechanical CLBP. We present a comprehensive clinical overview of restorative neurostimulation for refractory, disabling, mechanical CLBP. Impaired neuromuscular control and consequent degeneration of the multifidus muscles are implicated in the development and persistence of mechanical low back pain. Restorative neurostimulation targets these processes and aims to reverse these degenerative changes in the muscles and mechanoreceptor in the muscle spindles and, therefore, restore motor control of the multifidus muscles, playing an important role for functional stability of the lumbar spine. We detail the theory and rationale of the technology as well as appropriate patient identification and current trial evidence in this comprehensive overview of restorative neurostimulation.

Keywords: arthrogenic muscle inhibition; chronic mechanical low back pain; multifidus muscle; neuromuscular control; neurostimulation; restorative neurostimulation.

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Conflict of interest statement

CJG provides consulting for Iliad Lifesciences, Saluda, Persica, Presidio, and Biotronik. He serves on the Board of Directors of the International Neuromodulation Society and serves as Editor-in-Chief of Pain Practice. He also reports stock from Mainstay Medical. DWL reports consultation for Boston Scientific, Abbott, Mainstay Medical, Johnson & Johnson, Vertos Medical, Biotronik. ML reports personal fees from Mainstay Medical, outside the submitted work. MA reports personal fees for travel, presentation, and consulting from Mainstay Medical. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Evidence-based patient indication flow chart.
See this image and copyright information in PMC

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