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    Neurostimulation of lumbar muscles for refractory non-specific chronic low back pain

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    1 Draft recommendations

    1.1 Evidence on the safety of neurostimulation of lumbar muscles for refractory non-specific chronic low back pain shows well-recognised complications. Evidence on its efficacy is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.

    1.2 Clinicians wanting to do neurostimulation of lumbar muscles for refractory non-specific chronic low back pain should:

    • Inform the clinical governance leads in their healthcare organisation.

    • Give people (and their families and carers as appropriate) clear written information to support shared decision making, including NICE's information for the public.

    • Ensure that people (and their families and carers as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these.

    • Audit and review clinical outcomes of everyone having the procedure. The main efficacy and safety outcomes identified in this guidance can be entered into NICE's interventional procedure outcomes audit tool (for use at local discretion).

    • Enter details about everyone having neurostimulation of lumbar muscles for refractory non-specific chronic low back pain onto the National Neuromodulation Registry and review local clinical outcomes.

    1.3 Healthcare organisations should:

    • Ensure systems are in place that support clinicians to collect and report data on outcomes and safety for everyone having this procedure.

    • Regularly review data on outcomes and safety for this procedure.

    1.4 Patient selection should be done by a multidisciplinary team with experience in pain management and neuromodulation stimulation procedures.

    1.5 Further research should include suitably powered randomised controlled trials comparing the procedure with sham and current best practice with appropriate duration. It should report details of patient selection and long-term outcomes.