Restorative neurostimulation offers long-term relief for chronic low back pain in older adults

Chronic low back pain (CLBP) continues to be a leading cause of disability globally, especially among aging populations. In recent years, restorative neurostimulation has emerged as a novel and effective treatment for patients with mechanical low back pain due to multifidus muscle dysfunction, particularly those unresponsive to conventional therapy. A new study by Ardeshiri et al. (2025) in Regional Anesthesia and Pain Medicine, aggregating data from three independent clinical trials, sheds light on the effectiveness of this therapy in older patients — a group historically underrepresented in clinical trials.

Understanding the burden of chronic low back pain in older adults

Chronic low back pain affects up to 80% of adults at some point in their lives, with prevalence increasing with age. The condition leads to:

• Loss of mobility and independence
• Increased fall risk and hospitalizations
  Reduced quality of life
• Higher healthcare utilization and costs

Older patients often experience mechanical low back pain — pain linked to spinal movement or load — which is commonly rooted in dysfunction of the multifidus muscle, a deep spinal stabilizer. Unfortunately, this subgroup of patients often shows limited improvement from standard interventions such as physical therapy, analgesics, or corticosteroid injections.

What is restorative neurostimulation?

Restorative neurostimulation is an innovative therapy designed to target the underlying dysfunction of the multifidus muscle, rather than masking symptoms. It employs neuromodulation, a field that uses electrical stimulation to influence nerve activity.

Key features of restorative neurostimulation:

• Target area: Medial branch of the dorsal ramus at the L2 spinal nerve
• Device components:
  • Implantable pulse generator
  • Leads positioned near spinal nerves
• Therapy regimen:
  • Twice-daily 30-minute sessions
  • Generates smooth, tetanic contractions to retrain the multifidus muscle
• Goal: Restore spinal stability and reduce pain by reversing muscle inhibition
  

This therapy is branded as ReActiv8®, and has already demonstrated safety and efficacy in younger and middle-aged adult populations. The latest research focuses on older adults, addressing a critical knowledge gap.

Study design and cohort

This 2-year follow-up study combined data from:

1. ReActiv8-B (USA, UK, Europe, Australia)

2. ReActiv8-C (Germany)

3. ReActiv8-PMCF (UK)
   

Total participants: 333
Completers with 2-year data: 261
Age range: 22–82 years, grouped into quartiles for analysis
Older cohort (Q4): Median age 60 years (range 56–82)

Inclusion criteria

Participants met the following conditions:

• Adults (≥18 or 21, depending on region)
• Documented multifidus dysfunction via imaging or clinical assessment
• Failure of conservative treatments (physical therapy, medications)
• No surgical indications
• Medically suitable and able to operate the ReActiv8 device

Key results: How did older adults respond?

1. Pain reduction

• • ≥ 50% pain reduction: Achieved by 62% of older patients at 24 months.

• • This compares closely to 65% in the overall study population.
    

2. Disability improvement

• • Defined by a ≥ 15-point improvement in the Oswestry Disability Index (ODI):
    • 48% of older adults met this threshold
      

• • • Compared to 60% across all patients

3. Health-related quality of life (HRQoL)

• • Measured using EQ-5D-5L index:
    • Improved from 0.568 to 0.763 in older patients

• • • Compared to 0.544 to 0.769 in the total cohort

4. Mobility gains

• • Severe mobility issues dropped from 26% to 8% in older adults.
    
  • Younger groups saw similar reductions (from 12% to 3%).

Summary of 2-year outcomes

Step-by-step: Restorative neurostimulation

1. Assessment: Evaluation of back pain origin, physical function, and imaging to confirm multifidus dysfunction.

2. Patient selection: Ensure criteria are met, and alternative treatments have been exhausted.

3. Device implantation: Surgical implantation of leads and pulse generator under sterile conditions.

4. Programming: Personalized stimulation settings are adjusted.

5. Twice-daily use: Patients activate the device for 30-minute sessions at home.

6. Follow-up visits: Ongoing evaluation at 6, 12, and 24 months.

Implications for clinical practice

• Older adults benefit similarly to younger populations
• Multifidus dysfunction is a treatable root cause of CLBP
• Non-opioid and non-surgical treatment options are critical in geriatrics
• Restorative neurostimulation can reduce mobility impairment and promote independence
• Encourages multidisciplinary collaboration between pain specialists, geriatricians, and physiotherapists
  

Conclusion

Restorative neurostimulation offers durable, non-opioid relief for mechanical low back pain — and it’s equally effective in older patients. This groundbreaking therapy targets the root cause of dysfunction in the spine’s stabilizing muscles, offering a safe and meaningful solution for a population burdened by chronic pain and limited mobility.

As health systems face increasing demands from aging populations, this therapy may represent a paradigm shift in treating chronic back pain, especially in individuals where conventional methods have failed.

For more information, refer to the full article in Regional Anesthesia and Pain Medicine.

Ardeshiri A, Amann M, Thomson S, et al. Application of restorative neurostimulation for chronic mechanical low back pain in an older population with 2-year follow up. Regional Anesthesia & Pain Medicine 2025;50:231-236.

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