The Role of Neuromodulation Techniques for Management of Back Pain Based on Scientific Evidence

Enrique Latorre Marques

Abstract

Background: Low back pain (LBP) is characterized for its prevalence, great variability, high rates of disability and costs. Chronic Low Back Pain (CLBP) has excessive rate of surgery. Evidence based studies demonstrates only few techniques are cost-effective and many others dangerous. CLBP may originate in dysfunctional nociceptive processing within the central nervous system for that Neuromodulation offers emergent possibilities. Neuromodulation is reversible, adjustable, less invasive avoiding surgery and providing functional recovery. The cost is significantly lower and Quality of life clearly better than conventional pain therapy. The International Association for the study of pain (IASP) and the Special Interest Group on Neuromodulation (SIGN) is the leading forum for science to design therapeutic algorithms for back and neuropathic pain. Objectives: This Comprehensive Review explains concepts, epidemiology, cost, indications and types of Neuromodulation on management of LBP and radiating pain. Methods: A comprehensive review of literature: Clinical Guidelines, IASP sources, SIGN policies, focused on chronic low back pain (CLBP) and Failed Back Surgery Syndrome (FBSS). Also we include one big Meta-Analysis where were reviewed all Clinical Practice Guidelines (CPG), 871 Systematic Reviews, Randomized control trials (RCT´) and Prevention studies for COST B13 Program, literature reviews Searching in the Cochrane Library, Medline, Embase and other electronic databases. Results: Neuromodulation offers good and promising results in patients with CLBP and radiated intractable pain. RCTs demonstrated the efficacy without important side effects. Technological advances and clinical evidences continue to expand new modalities. IASP SIGN coordinate efforts including therapeutic algorithms based on scientific evidence. Conclusion: Neuromodulation is a safe, minimally invasive and reversible technique to relieve back and radiated pain when conservative management has failed, avoiding surgery and opioids. It is included in CLBP algorithms of management adopted by National Health Systems of European Union from 2005.