{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T05:26:24Z","timestamp":1789881984480,"version":"4.0.1"},"reference-count":35,"publisher":"BMJ","license":[{"start":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T00:00:00Z","timestamp":1755129600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Mainstay Medical","award":["PMCF"],"award-info":[{"award-number":["PMCF"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2025,7,14]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Chronic mechanical low back pain (CLBP) often stems from dysfunction of the multifidus muscle, leading to impaired motor control and pain. Restorative neurostimulation has emerged as a novel treatment targeting this dysfunction by delivering electrical stimulation to the medial branches of the L2 dorsal rami to restore multifidus activation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective, open-label, postmarket clinical follow-up study aimed to evaluate 5-year clinical outcomes and device utilization trends in a cohort of 42 patients with CLBP treated across five UK sites with restorative neurostimulation via an implanted ReActiv8 neurostimulation system. Patients were followed for 5 years, with assessments of pain (Numerical Rating Scale (NRS)), disability (Oswestry Disability Index (ODI)), and health-related quality of life (EuroQol-5 Dimension, 5 Level (EQ-5D-5L)) at baseline and regular intervals. Therapy utilization was collected via implantable device logs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>At 5 years, 34\/42 patients (81%) completed follow-up. Significant and durable improvements were observed in pain (mean NRS reduced from 7.0 to 3.2), disability (mean ODI reduced from 46.6 to 26.1), and quality of life (EQ-5D index increased from 0.426 to 0.703). A total of 82% of patients achieved a minimally clinically important change in either pain or disability, and 62% were pain remitters (NRS \u22643). Device usage averaged 1106 hours over 5 years, with reductions in usage over time. Lower usage was associated with non-response, though causality could not be determined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Restorative neurostimulation provides robust, sustained improvements in pain, function, and quality of life in patients with CLBP associated with multifidus dysfunction. These results support its long-term efficacy and safety in real-world clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      ClinicalTrials.gov Identifier:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT01985230\">NCT01985230<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rapm-2025-106899","type":"journal-article","created":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T09:30:20Z","timestamp":1755163820000},"page":"rapm-2025-106899","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["5-year longitudinal follow-up of patients treated for chronic mechanical low back pain using restorative neurostimulation"],"prefix":"10.1136","clinical-trial-number":[{"clinical-trial-number":"nct01985230","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct01985230","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3027-9343","authenticated-orcid":false,"given":"Simon","family":"Thomson","sequence":"first","affiliation":[{"name":"Mid and South Essex University NHSFT, Pain and Neuromodulation Orsett Hospital, Essex, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Williams","sequence":"additional","affiliation":[{"name":"North Bristol NHS Trust, Westbury on Trym, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Girish","family":"Vajramani","sequence":"additional","affiliation":[{"name":"University Hospital Southampton NHS Foundation Trust, Southampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manohar","family":"Sharma","sequence":"additional","affiliation":[{"name":"The Walton Centre NHS Foundation Trust, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Love-Jones","sequence":"additional","affiliation":[{"name":"North Bristol NHS Trust, Westbury on Trym, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajiv","family":"Chawla","sequence":"additional","affiliation":[{"name":"The Walton Centre NHS Foundation Trust, Liverpool, UK"},{"name":"Pain Specialists Australia Melbourne, Richmond, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9250-1886","authenticated-orcid":false,"given":"Sam","family":"Eldabe","sequence":"additional","affiliation":[{"name":"Department of Pain Medicine, The James Cook University Hospital, Middlesbrough, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,8,14]]},"reference":[{"key":"2025081402301051000_rapm-2025-106899v1.1","doi-asserted-by":"publisher","DOI":"10.2519\/jospt.2019.8827"},{"key":"2025081402301051000_rapm-2025-106899v1.2","doi-asserted-by":"publisher","DOI":"10.1016\/0268-0033(86)90146-4"},{"key":"2025081402301051000_rapm-2025-106899v1.3","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.apmr.2016.05.016","article-title":"Is there a relationship between lumbar proprioception and low back pain? 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