By Steve Spencer

If you’re reading this and you’re over 40, odds are you’ve had at least one experience with back pain. In fact, back pain is the second most common reason people visit the doctor, behind only head colds.

Enter Bradley Goodman, MD. Goodman, who practices with OrthoAlabama Spine & Sports, has always been an early adopter of medical technology. He was the first doctor in the United States to offer Superion, a minimally invasive implant to treat spinal stenosis. He was also the first in the country to perform the Intracept procedure to treat vertebrogenic pain.

So naturally when ReActiv8® came on the scene, Goodman was excited. “The beauty of ReActiv8® is that it’s designed to rehabilitate, not just alleviate pain,” he said. “Over the years, I’ve joked that when dealing with pain, I was a glorified hairdresser. I didn’t get rid of the gray hair. I was just putting color in there. Now we can actually do something about pain rather than just offering palliative treatments like nerve blocks.”

ReActiv8® focuses on mechanical chronic lower back pain (CLBP), one of the most common types of CLBP. Many people with CLBP find themselves unable to sit for an extended period without their pain increasing. The pain is often unrelenting. Mechanical CLBP can start from a number of issues, anything from a herniated disc to a vertebral fracture. Regardless of the cause, the pain can become debilitating, and as a person reacts by moving less and less, the multifidus muscle, which runs along the length of the spine, begin to atrophy. This is critical because the multifidus stabilizes the back, and when it’s weakened, it leads to instability in the lower back, causing chronic pain.

“We can see the atrophied multifidus on an MRI,” Goodman said. “But over the 30 years I’ve been doing this, I ignored it because there's nothing we could do about it. We can put patients in physical therapy, but because that muscle has been disinhibited for so long, the therapist can't really reactivate it. After months or maybe years of disuse, the brain has turned off that pathway.”

The ReActiv8® Restorative Neurostimulation system changes this. ReActiv8® is a small generator, about the size of a matchbox, that is implanted under the skin in the lower back through a minimally invasive outpatient procedure. Similar to a TENS unit, it targets the nerves that innervate the multifidus muscle with electrical pulses delivered through lead technology. The stimulator is bypassing the neural pathway that has been shut off to reactivate the multifidus muscle. After the procedure, the patient uses the stimulator with twice a day, 30-minuate sessions, which can feel like a deep tissue massage. Now that the multifidus muscle is reengaged, they can also participate in physical therapy.

So far, the device has proved to be very effective. In a trial, clinicians asked patients to rate their pain intensity using a visual analog scale (VAS) score before the device was implanted. Three years later, when the same patients were asked to rate their current pain level, 77 percent of them reported a pain reduction of 50 percent or greater.

One of Goodman’s early patients was Kelly East. Her pain was constant. She was unable to sleep on her left side, and she was having spasms. Her hip and her legs would go numb. She’d be up until 2:00 a.m., straining to get comfortable, trying to sleep. This woman who used to enjoy working in the yard, cutting grass and weed eating, now could barely bend over to pick up a plate. She had been getting nerve blocks, but they only worked for two or three weeks. Doctors found multifidus atrophy on an MRI and referred her to Goodman. After the ReActiv8® procedure had reactivated her multifidus muscle, she started physical therapy. Today, she is back to cutting the grass, engaging comfortably in all the activities she did before.

Not everyone is a candidate for ReActiv8®, but for the many people whose chronic back pain is due to multifidus atrophy, there is finally a therapy that doesn’t just alleviate the symptoms; rather, one that can actually attack the source of the problem.