How a zapper inside your body can help banish lower back pain

THE PATIENT

AGONISING pain in my lower back came out of the blue about 19 years ago. It started as a constant dull ache, and my GP told me to try to cope with it, as they didn’t know the cause, and said it was just one of those things.

But it got worse and became so bad that, at times, I couldn’t walk or sleep properly. The pain was excruciating, worse than childbirth — sometimes, the only way I could get about was to crawl.

I couldn’t carry on working because the pain made it impossible to stand up for very long. So I was stuck at home — it was miserable and frustrating.

In 2013, I asked my GP to refer me to a specialist and went to St Bartholomew’s hospital, in London, a few weeks later.

I had an MRI scan and an X-ray, which revealed I had chronic spondylosis, where the discs in the spine were crumbling away, so my bones were rubbing against each other and pinching my nerves. That’s why I was in such agony.

The doctor said that my brain was also sending messages to stop the muscles in my back being activated, to stop me moving and prevent pain. But this meant the muscles weren’t getting exercised, so weren’t strong enough to support my spine properly — which added to the pain, as there was so much pressure on the damaged discs. I was given physiotherapy and steroid injections but, after two to three weeks, the pain would return. I was also prescribed morphine-based painkillers, but they didn’t always work.

I had almost given up hope and was desperate to try anything. I even considered surgery to fuse the bones in my back together — but surgeons said there were risks involved.

Then, in 2015, one of the doctors phoned to ask if I’d be interested in taking part in a trial for a new implant: it was like a heart pacemaker, but would send electrical pulses to stimulate and strengthen the muscles around my spine.

The idea was that the stronger muscles would take the strain off the damaged spine and reduce pain. I could control the strength of the signals with a remote control. I was so desperate that I didn’t hesitate to say ‘yes’. I had the 90-minute procedure in March 2015 under general anaesthetic.

When I woke up, there was hardly any pain. I was told not to shower until the wounds healed, and took painkillers and antibiotics to prevent infection.

Getting used to the pulses was uncomfortable at first. I hold the remote control against the skin on my back for a couple of seconds, then press a button. Then I lie on my front while the device sends the pulses.

You feel the implant’s pulses down the spine for 20 seconds and the muscles tense up, then the pulses stop for ten seconds and start again — for half-anhour. I do this twice a day.

The implant has significantly improved my pain.

In the two years since the operation, I’ve had about ten bad days, which I’d score as an 8/10 for pain. The implant’s battery lasts five years, but I’m hopeful it should have strengthened my muscles enough by then for me not to continue any treatment.

I still take painkillers, but now I can play with my grandchildren and am going back to work — this time as a phlebotomist (someone who takes blood from patients), which is incredible. I enjoy having my life back.

THE SPECIALIST

VIVEK Mehta is a consultant in pain medicine at Barts health NHS trust in London. Lower back pain is very common. one of the major triggers is disc disease — where the gel-filled discs between the bones in the spine are worn out, meaning bones rub and grind, causing inflammation and pain.

Around two in five cases of lower back pain are ‘discogenic’, related to disc disease, as was the case with Sharon.

In these patients, the brain tries to suppress painful movement by limiting the activity of these muscles, which exacerbates the problem.

The muscles become weak from under-use and cannot support the spine properly. This leads to abnormal spine movements and more pain. Patients’ lives become very restricted.

Treatment involves physiotherapy to try to strengthen the muscles running down either side of the spine.

It’s like a crumbling wall: you put a support next to it to stop it falling down. But the benefits of physiotherapy are limited where there is severe wear. Steroid injections can help reduce the inflammation, and strong morphine-based painkillers are an option, but can lead to dependence.

Surgery to fuse the bones in the back to stop them rubbing is possible, but it comes with risks, such as nerve damage and reduced flexibility. There’s also no evidence that pain improves.

I have been involved in trialling a new treatment that helps patients such as Sharon.

electrical pulses are used to stimulate muscles. we target the dorsal nerves in the spinal cord which supply the muscles.

we use a battery-powered pacemaker-type device called reActiv8 — it’s like internal physiotherapy and the electrical impulses exercise the muscles for 30 minutes twice a day.

The device is implanted in an operation taking an hour-and-a-half. we make 2in-long incisions — one in the centre of the lower back along the spine, and the other in the buttock below the bikini line. we insert two electrodes inside the muscle on either side of the spine.

The electrodes are connected with wires to the pacemaker device, which is fitted in the buttock. we use live X- ray images to ensure we are in the correct positions and, once in place, we check if the muscles are contracting normally by touching the patient’s back, as you can feel the contractions.

we then use dissolvable stitches to close the incisions.

Patients may still need painkillers occasionally, but some will come off them altogether or reduce the dose.

As part of the year-long trial, we did a check-up a week after the treatment, then every month, and then after a year.

we’ve been taking part in the international reActiv8 trials and have had promising results from the 46 patients it has been tested in so far. The findings, which were presented at the International neuromodulation Society congress in June, showed that 63 per cent of 46 patients had significant improvements in pain, disability and quality of life after 90 days.

It is available privately or on the NHS as part of trials — Barts is now taking part in a larger study in 128 patients. The hope is that it will eventually be recommended by NICE and more widely available. LOWER back pain is the biggest cause of disability in the UK, affecting nearly one in ten people. Sharon Palmer, 55, a mother of four and former care home manager from Hornchurch, Essex, had a new implant to ease the pain, as she tells SOPHIE GOODCHILD.

the operation costs £18,000 to £20,000 both privately and to the NHS.