New device stimulates weak lower back muscles to resolve chronic pain

Dennis Bassett was just trying to help out a friend. In his twenties and healthy, he thought nothing of throwing his body weight behind his friend’s stalled car to get it rolling — until he felt and heard a troubling squish in his lower back.
 
Forty years later, Bassett still isn’t exactly sure what he tweaked in his back. What he does know is that the pain from that fateful push never went away. For years, the 64-year-old real estate agent and home renovator from Hempstead struggled with lower back pain. At times, his pain was so intense he could barely climb the front steps to his home.

Bassett tried physical therapy, steroid injections and nerve blocks — they eased his discomfort for a while, but the relief quickly faded. At his wits’ end, he made an appointment with his doctor, Kiran Patel, MD, director of neurosurgical pain at Lenox Hill Hospital to discuss other options. Was it time to consider surgery?

An operation wouldn’t solve his problem, Dr. Patel told Bassett. But she had a less invasive solution that might help.

A non-surgical chronic back pain treatment

Like Bassett, 30 million Americans live with chronic low back pain, which is defined as pain that lasts more than three months. “It’s one of the top reasons people see a doctor,” says Dr. Patel. “Two out of three adults will experience some type of lower back pain at some point in their lives.” Of that group, seven percent will develop lasting, chronic pain that puts a serious ding in their quality of life.

Many of her patients ask about surgery, assuming it will fix them. But open back surgery only helps when there’s something structurally wrong with the spine, Dr. Patel says. In Bassett’s case, a magnetic resonance imaging (MRI) scan and a physical exam showed that his spine was normal. 

The source of his pain: A weak multifidus

Still, his evaluation did reveal a problem. He had a weak multifidus, a bundle of muscles in the lower back that flank and stabilize the vertebrae of the lumbar spine.

“With certain lower back injuries, the nerves in the lower back muscles stop communicating correctly with the brain,” Dr. Patel says. As a result, the brain essentially stops activating the correct sequence of muscles in the lower back. Over time, the muscles weaken, compromising the spine’s stability and ultimately causing pain.

Over time, the loss of muscle strength and stability can cause the muscle to atrophy, or waste away. This, in turn, can cause the compression of the vertebra and a plethora of other back-related problems, such as osteoarthritis, herniated discs, pinched nerves and bone spurs (spinal osteophytes).

Sometimes, Dr. Patel says, patients with weak multifidus muscles can rehabilitate the muscles before they shut down. Alas, physical therapy didn’t provide lasting help for Bassett, but an innovative new approach might offer relief, Dr. Patel told him. One of a number of fresh back pain solutions available at Lenox Hill Hospital, a device called ReActiv8 has been shown to have good results, helping lower back pain sufferers decrease their pain and improve their activity level by reactivating the muscles of their lower back — while avoiding invasive surgery.

ReActiv8 is a two-by-two-inch square implant that is placed in the lower back to stimulate nerves and naturally contract weak muscles. Through gentle electronic pulses, the implant triggers controlled contractions in the multifidus, which improves the brain’s muscle control over time, restoring stability to the spine and resolving patients’ pain.

Approved by the FDA in 2020, “ReActiv8 is a powerful new tool for us at Lenox Hill,” Dr. Patel says. In a large clinical trial, roughly three out of four patients experienced at least a 50% reduction in pain within a year of receiving the implant; the improvement was maintained and even increased as time went on. Additionally, after three years of therapy, 71% of patients who had been taking opioids for pain at the start of the study had chosen to stop or reduce the medication. Bassett liked the way Dr. Patel described the device. The procedure to place it would be quick, she said, and shouldn’t sideline him for long.

“When she told me I’d be in and out of the hospital the same day, I was all in,” Bassett says. 

In July, Bassett underwent a one-hour outpatient surgery at Lenox Health Greenwich Village to have the device implanted in his lower back, just below where his waistband hits. Upon discharge, Bassett was given a wireless remote and simple operating instructions. Twice a day, for 30 minutes, he was to lie down, tap a button on the remote and activate the implant. And that would be it. As he did his rehab, he’d regularly follow up with Dr. Patel and report on his progress.

Bassett got used to his new routine in no time. “I can feel the muscles contracting and relaxing, but it doesn’t hurt,” he says. These days, he settles into bed at night, presses the button on his remote and falls asleep as the device works its magic. 

It may take up to six weeks of use for patients to notice an improvement, Dr. Patel says. She may remove the implant when Bassett’s muscles are working correctly again. Happily, though, Bassett says he’s already in much less pain. He’s feeling less stiff and more capable of a range of activities, from tending to yard work to playing with his grandchildren. “I used to come home so tired and hurt, but my kids and grandkids tell me I’m like a new man,” he says. “I’m the go-to guy for everything that needs to get done — I like to take care of my family.” 

Success stories like Bassett’s are exactly the kind that Dr. Patel loves to hear. “Providing patients with minimally invasive low back pain options is really essential to improving their quality of life,” she says. 

Sometimes, solving a pain relief puzzle means trying something new. Bassett says he’s glad he did.

Lenox Hill recently began offering another minimally invasive intervention for patients with back pain: Intracept®, a procedure that harnesses the power of heat to prevent pain. Intracept uses radiofrequency ablation (RFA), aiming radio waves at nerves that are sending pain signals in order to heat and disable them. David Langer, MD, chair of neurosurgery at Lenox Hill Hospital, was the first in New York City to perform the procedure; it’s also offered by fellow neurosurgeon Yafell Serulle, MD, at Lenox Hill Hospital, and Kiran Patel, MD, at Lenox Health Greenwich Village.

RFA isn’t a new approach for back pain — doctors have been using it for years. In the past, though, it’s typically been used on nerves that are able to regenerate, thanks to a protective coating called a myelin sheath. That meant patients had to repeat treatments every six months. Intracept, however, targets a sensory nerve that snakes through the center of the spine, known as the basivertebral nerve, which doesn’t have that protective covering. Once zapped by Intracept, it shuts down permanently. 

“It’s made a big difference for many of my patients,” Dr. Patel says. Combining Intracept with interventions such as physical therapy and healthy lifestyle changes (losing weight and stopping smoking, for example) may do even more to curb back pain. “Often patients need to try a lot of different things to find what works for them,” Dr. Patel says. “Curing back pain takes time. But treatments like these can help.”