However, the ability of SCS to successfully manage chronic axial LBP has been associated with mixed results and limited efficacy often with declining efficacy over time. Traditional low-frequency (ie frequency ≤1000 Hz) paresthesia based SCS has been shown to be clinically effective for many pain conditions including PLPS. Traditional Low-frequency Paresthesia-based SCS 1, 13–15 Here, we will provide an up-to-date narrative review of the scientific evidence of neurostimulation therapies with a focus on the management of chronic axial LBP. Due to a multitude of recent technological and hardware advancements, including programming (eg novel waveform patterns and alterations in programming parameters and energy delivery), new neural targets, and improved lead placement neurostimulation has improved in its ability to treat axial LBP. The use of neurostimulation for the treatment of chronic LBP has been met with mixed results. 10, 11 When treating PLPS, SCS has traditionally been used to target radicular symptoms, but at times lacks effective prolonged coverage of axial LBP symptoms. More specifically, SCS has been used extensively for the treatment of PLPS (approximately 70% of all implants) however, it has not yet been fully investigated as a treatment modality for patients who have not previously undergone back surgery. 7–9 Spinal cord stimulation is now a widely accepted form of therapy for chronic intractable neuropathic pain and is the most commonly employed neurostimulation therapy for the treatment of chronic pain. Since the first SCS unit was implemented in a clinical setting by Shealy, SCS has been growing in popularity as its clinical safety, cost utility, and efficacy increase. Forms of neuromodulation, such as spinal cord stimulation (SCS), have been utilized over the last 50 years to assist in the treatment of intractable LBP often with a radicular component. Unfortunately, the treatment of chronic LBP can be challenging and refractory to many interventions. Further classifications can be subdivided into individuals that have chronic LBP following back surgery (eg postlaminectomy pain syndrome PLPS) and those that have nonsurgical refractory LBP. Pain that chronically occurs concurrently in the back and the leg is considered back and leg pain. As defined by NASS (North American Spine Society), chronic LBP is “pain of musculoskeletal origin extending from the lowest rib to the gluteal fold that may at times extend as somatic referred pain into the thigh.” 6 Chronic pain that is localized in the lower back is considered axial LBP, while pain that radiates past the buttock and down the leg(s) is classified as radicular pain. 5 A well-defined underlying pathological cause may not always be identified. In reference to time, chronic back pain is typically defined as pain lasting longer than 12 weeks or beyond the expected period of healing. When discussing chronic LBP, it is important to provide a contextual definition. 1–3 Chronic LBP is associated with significant direct health-care costs including physical therapy, inpatient services, prescription medications, and interventional care, as well as indirect costs including lost work productivity. Approximately one in five adults suffer from chronic low back pain (LBP) with over 575 million individuals suffering worldwide.
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