How Nerve Stimulation Can Help Manage Chronic Back Pain
Chronic low back pain is the most common form of back pain, affecting millions of adults and can slowly take over daily life. According to the New England Journal of Medicine, about two-thirds of patients with chronic low back pain suffer from mechanical pain.
Mechanical low back pain refers to back pain that arises intrinsically from the spine, intervertebral disks, or surrounding soft tissues. The issue can have many causes, though 70% of cases arise from lumbosacral muscle strains/sprain.
Many people get stuck in a cycle of short-term fixes. They try physical therapy. They take medications. They receive injections. The root cause is never addressed. Relief may fade, and the pain returns.
This is where back pain and restorative nerve stimulation may offer a different path. Traditional nerve stimulators such as spinal cord stimulators deliver targeted electrical signals to the spinal cord to block pain signals. These treatments are considered palliative because they focus on masking discomfort.
ReActiv8 is different. It is an implantable neuromodulation system that delivers electrical stimulation to the nerves innervating the lumbar multifidus muscles, eliciting controlled muscle contractions as an aid in the management of chronic low back pain associated with multifidus muscle dysfunction.
This approach is distinct from other peripheral nerve stimulation modalities, which primarily target sensory nerves to modulate pain perception rather than directly activating spinal stabilizing musculature.
If other treatments have not worked, it may be time to explore a restorative option. Check out Mainstay Medical’s resources to learn more about whether you could be a candidate for ReActiv8 Restorative Neurostimulation.
Understanding Chronic Back Pain: When the Pain Doesn’t Stop
Low back pain is common, but not all back pain is the same.
Acute back pain usually starts suddenly. It may follow a strain, fall, or lifting injury. In many cases, it improves within a few days to a few weeks as the body heals.
Chronic back pain is different. It lasts 12 weeks or longer, even after the original injury should have been resolved. For some people, there is no clear new injury at all. The pain simply does not go away.
This can happen because of a deeper issue with how the spine stabilizes itself. The body relies on small, deep muscles to support the lower back during movement. If these muscles are not activating properly, the spine can become unstable.
Over time, this instability can lead to ongoing stress, inflammation, and pain. Even if the first injury heals, the underlying dysfunction remains.
That is why chronic low back pain often requires a different approach than short-term care.
What Is Neurostimulation for Chronic Back Pain?
Neurostimulation uses low energy electrical pulses to target specific nerves in the body, usually via a small surgical implant. In people with chronic low back pain, those pulses are delivered to nerves that either sense pain or control muscles.
The idea is simple: The nervous system carries signals between the brain and the body. If those signals are disrupted or retrained, pain patterns can change.
There are two main types of neurostimulation:
1. Mask or interfere with pain signals
Some implant systems send electrical signals that compete with pain messages traveling to the brain. This can reduce how strongly pain is felt. This type of therapy is designed for symptom relief but does not provide a definitive treatment for the underlying disorder.
2. Restore function and break the pain cycle
Other approaches focus on activating specific nerves that control key stabilizing muscles in the lower back. By improving muscle control and spinal stability, the goal is to address the root cause of mechanical pain.
Both approaches use an implanted or external device. But the intent behind the therapy matters.
One focuses on blocking pain signals. The other focuses on rehabilitation to treat pain.
Nerve Pain vs. Mechanical Pain: Understanding the Two Types of Chronic Low Back Pain
Chronic low back pain is not one single condition. It often falls into two main categories: nerve pain and mechanical pain. Understanding the difference is key to choosing the right treatment.
Nerve Pain
Nerve pain happens when a spinal nerve is compressed, injured, or irritated. This may be caused by a herniated disc or spinal narrowing.
Common symptoms include:
- Sharp or burning pain
- Pain that travels down the leg
- Numbness or tingling
- Weakness in the leg or foot
This type of pain is often called radicular pain or sciatica. It typically follows the path of a nerve or nerve root.
Neurostimulation for nerve pain is typically designed to interfere with pain signals before they reach the brain. The goal is symptom control.
Mechanical Pain
Mechanical pain is different. It usually stays in the lower back and does not travel down the leg. According to research, about two-thirds of chronic low back pain cases are mechanical (Deyo, Will).
Common symptoms include:
- Aching pain in the lower back
- Pain that worsens with sitting or bending
- Stiffness or muscle fatigue
- Relief when lying down
Mechanical pain is often linked to dysfunction in the deep stabilizing muscles, including the multifidus muscle.
Neurostimulation for mechanical pain focuses on restoring muscle activation and spinal stability. Instead of masking pain, the goal is to improve function.
For people who have failed conservative care, proper diagnosis is critical. Physicians may use MRI imaging to look for multifidus muscle dysfunction. Identifying this issue can provide a clearer picture of chronic low back pain and guide the most appropriate therapy.
Take Our Chronic Low Back Pain Quiz
How Different Nerve Stimulation Technologies Work
“Neurostimulation” is an umbrella term for several technologies. However, these are not interchangeable options a patient can simply choose between. Each one is indicated for specific pain mechanisms or pathologies, and it may not work if the diagnosis is wrong.
That is why correct diagnosis is essential. Two people can both say “chronic low back pain,” but their pain may be mechanical (nociceptive), neuropathic, or nociplastic. The best-matched therapy depends on which one is driving symptoms.
| Technology | What it targets/where it is located | How it works | Indicated use in CLBP (high level) |
| Spinal Cord Stimulation (SCS) | Leads placed in the epidural space (between the spinal cord and vertebrae) to target specific spinal cord pathways | Block pain signals | Chronic, intractable nerve pain of the trunk and/or limbs, including unilateral or bilateral pain associated with failed back surgery syndrome and intractable low back and leg pain |
| Peripheral Nerve Stimulation (PNS) | Targets specific peripheral nerves (that lie outside the brain and spinal cord); lead placed near or alongside a particular peripheral nerve | Block pain signals | Neuropathic back pain |
| TENS | Skin‑applied electrodes to target peripheral nerves in the skin, muscles, and connective tissue | Block pain signals | Mild, short-term muscle discomfort |
| ReActiv8 (Multifidus Muscle Stimulation) | Leads placed near the medial branch nerves that supply the lumbar multifidus muscle | Causes controlled contractions of the multifidus muscle by aiming to address the underlying cause |
Mechanical CLBP with multifidus dysfunction |
Spinal Cord Stimulation (SCS)
In SCS, leads are placed in the epidural space, near the spinal cord. The electrical pulses block pain signals before they reach the brain. In chronic low back pain, it is only proven to be effective for neuropathic CLBP.
This approach is palliative. It focuses on symptomatic relief rather than restoring muscle function.
Peripheral Nerve Stimulation (PNS)
PNS targets specific peripheral nerves outside the brain and spinal cord. In the low back, it has mainly been suggested for pain management in adults with severe, intractable chronic pain of peripheral nerve origin, such as the cluneal nerve.
It is not intended to treat mechanical causes of low back pain.
Transcutaneous Electrical Nerve Stimulation (TENS)
TENS is non-invasive and many patients encounter it during physical therapy. It provides an electric stimulus for back pain through electrodes placed on the skin surface.
It is a palliative tool for mild muscle pain. The stimulation does not penetrate deep enough to contract the multifidus or address an underlying mechanical cause.
Multifidus Muscle Stimulation Systems (ReActiv8®)
ReActiv8 is different from other neurostimulators because it aims to rehabilitate the muscle. It is a back stimulation implant designed to stimulate the nerves that activate the multifidus muscles, which are key stabilizers of the spine.
Multifidus dysfunction is a mechanical (nociceptive) pain condition in which low back pain results from impaired activation of the lumbar multifidus muscles and loss of segmental spinal stability—not from nerve injury. Neurostimulation systems that primarily block pain signaling are therefore not the ideal treatment when multifidus dysfunction is the primary pain generator. Conversely, ReActiv8 is designed to restore multifidus function and is not intended to treat neuropathic or radicular leg pain.
Take Our Chronic Low Back Pain Quiz
The Treatment Journey: What to Expect
Considering an implanted therapy can feel overwhelming. Knowing the steps ahead can make the process feel more manageable.
ReActiv8 is not a quick fix. It is a structured, restorative approach designed for the right patient with the right diagnosis.
Step 1: Comprehensive Evaluation & Patient Screening
The journey begins with a detailed evaluation by a pain specialist. This includes reviewing your history, past treatments, imaging, and current symptoms.
The goal is to confirm that your chronic low back pain is mechanical in nature and that your pain has not responded to conservative care such as physical therapy, medications, or injections.
Careful screening helps ensure the therapy matches the pathology.
Step 2: Be Confident in Your Diagnosis
Do not hesitate to seek clarity, and second opinions can be valuable.
Your physician may review your MRI to rule out or confirm multifidus muscle dysfunction. Identifying this mechanical issue is essential before considering a restorative treatment option. A clear diagnosis guides the right therapy.
Step 3: The ReActiv8 Procedure
If you qualify, the ReActiv8 system is implanted during a minimally invasive surgery. Leads are placed to stimulate the nerves that activate the multifidus muscles.
Therapy typically begins a few weeks later and is focused on restoring muscle control over time.
Step 4: Long-Term Management
Patients control therapy sessions with the ReActiv8 Activator, which is similar to a remote control. For maximum benefit, patients should perform two 30-minute therapy sessions per day, usually once first thing in the morning, and once before bed.
Over time, the goal is improved spinal stability and reduced pain.
Evidence and Outcomes: Does ReActiv8 Really Work?
When considering an implantable therapy, evidence matters. Chronic low back pain is complex, and different technologies are supported by different data depending on what they are designed to treat.
It is essential to separate evidence for neuropathic pain therapies from evidence for treatments targeting mechanical dysfunction. Success with neurostimulation will depend greatly on a patient receiving the appropriate device for their correct diagnosis.
Significant Pain Reduction and Improved Function
For certain types of chronic low back pain, spinal cord stimulation has demonstrated the ability to reduce pain by interfering with pain signaling pathways. These therapies are supported for a wide range of indications but are not designed to treat mechanical pain or spinal instability.
ReActiv8 has been studied specifically in adults with mechanical CLBP associated with multifidus dysfunction. Clinical trials have demonstrated meaningful and sustained reductions in pain scores, along with improvements in disability and function over time (Gilligan).
Because ReActiv8 stimulates the nerves that activate the multifidus muscle, its goal is not simply to mask pain. It is designed to restore muscle control and improve spinal stability by addressing the underlying mechanical cause.
Improvements in Daily Function
In clinical studies, patients treated with ReActiv8 experienced improvements in functional outcomes and disability indices. These measures reflect increased ability to perform daily activities (Gilligan).
As with all therapies, outcomes vary. Careful diagnosis and patient selection remain critical to achieving the best possible results.
Take Our Chronic Low Back Pain Quiz
Addressing Common Questions and Concerns About ReActiv8 Neurostimulation for Chronic Pain
It is normal to have questions about implanted devices. Clear information can help you feel more confident as you explore your options.
Is the procedure safe? What are the risks?
ReActiv8 has a well-known safety profile. It has been studied in five clinical studies involving 567 patients. The procedure does not alter the structures of the spine, and you can have the device removed or explanted in the future. It has shown a favorable safety profile compared to other implantable neurostimulators.¹
That said, the implantation of ReActiv8 involves risks associated with the surgery, implantation, and use of ReActiv8 and may include:
- Pain at implant site
- Undesirable sensations or uncomfortable contractions of the muscles
- Muscle fatigue or spasms
- Scar tissue and stiffness
- Erosion, device malfunction, or migration
- Lack of pain relief
- Hematoma, seroma, infection, and other surgical risks
Always talk to your doctor about the potential risks and benefits of ReActiv8. For additional safety and product information, visit www.mainstaymedical.com/safety.
Will I feel the stimulation?
Yes. Patients report that therapy sessions feel like a pleasant series of deep muscle contractions, similar to flexing a muscle in an arm or leg, but in the lower back. Some compare the sensation to a deep tissue massage.
At follow-up visits, programming can be adjusted to ensure sessions remain comfortable and appropriate for daily therapy use.
Can I undergo MRI scans with an implant?
ReActiv8 patients can have an MRI under certain conditions. You must consult with your healthcare provider before an MR exam and inform MRI site personnel that you have an MR Conditional medical device during screening.
Carry your device identification card at all times. Because the device must be turned off before the MRI, you will need an appointment with a ReActiv8 representative before your MRI appointment.²
Taking the Next Step Toward Relief
Chronic low back pain can feel exhausting, especially after months or years of treatments that did not last. The most important step forward is a clear and accurate diagnosis. Mechanical pain, nerve pain, and other pain types require different approaches.
Trust that your physician’s role is to identify the true source of your pain before recommending any advanced therapy. The right treatment begins with the right diagnosis.
If you are ready to explore whether a restorative therapy like the ReActiv8 implant is right for you, the best next step is to get more information.
Check your qualification today and prepare to talk to your doctor about a solution that addresses the cause of your pain.
- Mainstay Medical data on file. ReActiv8 leads are positioned outside the spinal canal, unlike SCS leads, which are placed within the canal. This reduces the risk of serious procedure-related complications such as dural puncture, CSF leak, epidural abscess/fibrosis/hematoma, spinal cord/neurologic injuries and paralysis.
- Refer to The ReActiv8 System MRI Guidelines at www.mainstaymedical.com/resources for complete conditions information. Magnetic resonance imaging – The ReActiv8 Implantable Pulse Generator (IPG) and implantable leads are MR Conditional devices with demonstrated safety in the MR environment only within specified conditions. Refer to the document ReActiv8 System Magnetic Resonance Imaging (MRI) Guidelines for an up-to-date list of approved MR Conditional components, model numbers and required conditions for safe use in the MR Environment. Direct the patient to consult with their healthcare provider prior to an MR exam and inform MRI site personnel that they have an MR Conditional medical device during MR screening prior to the MR exam. Failure to follow these guidelines for MRI scans may result in severe patient injury and/or device malfunction.
