Summary of Recommendations

Document Overview

Design and created by Guideline Central in participation with the American Society of Pain and Neuroscience.

Neurostimulation for the Treatment of Non-Surgical Low Back Pain

American Society of Pain and Neuroscience

Publication Date: Mar 14, 2025

Page Last Updated: May 5, 2026

Recommendation Grading

Grade	Description	Suggestions for Practice
A	Service is recommended. There is high certainty that the net benefit is substantial.	Offer or provide this service.
B	Service is recommended. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.	Offer or provide this service.
C	Recommends selectively offering or providing this service to individual patients based on professional judgment and patient preferences. There is at least moderate certainty that the net benefit is small.	Offer or provide this service for selected patients depending on individual circumstances.
D	Recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.	Discourage the use of this service.
I	Concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.	Read the clinical considerations section of USPSTF Recommendation Statement. If the service is offered, patients should understand the uncertainty about the balance of benefits and harms

Level of Certainty	Description
High	The available evidence includes consistent results from well-designed, well-conducted studies in representative primary care populations. These studies assess the effects of the preventive service on health outcomes. This conclusion is therefore unlikely to be strongly affected by the results of future studies. Evidence Level: I-A - At least one controlled and randomized clinical trial, properly designed
Moderate	The available evidence is sufficient to determine the effects of the preventive service on health outcomes, but confidence in the estimate is constrained by such factors as: The number, size, or quality of individual studies. Inconsistency of findings across individual studies. Limited generalizability of findings to routine primary care practice. Lack of coherence in the chain of evidence. As more information becomes available, the magnitude or direction of the observed effect could change, and this change may be large enough to alter the conclusion. Evidence Level I-B - Well-designed, controlled, non-randomized clinical trials (Prospective Observational studies conforming to STROBE criteria) or Evidence Level I-C - Retrospective cohort or large case studies (>20 subjects)
Low	The available evidence is insufficient to assess effects on health outcomes. Evidence is insufficient because of: The limited number or size of studies. Important flaws in study design or methods. Inconsistency of findings across individual studies. Gaps in the chain of evidence. Findings not generalizable to routine primary care practice. Lack of information on important health outcome Evidence Level II - Expert opinion based of risk-to-benefit or based upon case reports
NG	Not graded or not provided

Document Overview

Document Title: Use of Neurostimulation for the Treatment of Non-Surgical Low Back Pain

Authoring Society: American Society of Pain and Neuroscience

Document Publication Date: Mar 14, 2025

Page Last Reviewed/Updated: May 5, 2026

Document Type: Consensus Statement

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: www.dovepress.com/an-evidence-based-consensus-for-the-use-of-neurostimulation-for-the-tr-peer-reviewed-fulltext-article-JPR

Source Citation: Deer TR, Pope JE, Petersen EA, Abdallah RT, Amirdelfan K, Azeem N, Bansal V, Barkoh K, Chapman KB, Denis DR, Dorsi MJ, Escobar A, Falowski SM, Garcia RA, Hagedorn JM, Heros RD, James WS, Kalia H, Lansford T, Malinowski MN, Manzi SM, Mehta P, Moghim RZ, Moore GA, Motivala SL, Navalgund YA, Patel RG, Pilitsis JG, Schatman ME, Shumsky PM, Strand NH, Tomycz ND, Yue JJ, Sayed D. An Evidence-Based Consensus for the Use of Neurostimulation for the Treatment of Non-Surgical Low Back Pain: The NEURON Group. J Pain Res. 2025;18:1247-1274

Document Scope, Criteria, and Use Cases

Document Objectives: The use of electrical neuromodulation has often been limited to those with previous back surgery, peripheral neuropathy, and complex regional pain syndrome. Many patients with severe intractable low back pain were thought to be candidates for spinal cord stimulation (SCS), dorsal root ganglion stimulation, or peripheral nerve stimulation but did not meet the criteria. Recently, additional high-level data has supported the use of SCS in non-surgical low back pain (NSLBP), and United States Food and Drug Administration approval has been granted. The American Society of Pain and Neuroscience (ASPN) executive committee realized an unmet need to develop criteria for patient selection for this specific patient population. This is a NEURON project (neuroscience, education, utilization, risk mitigation, optimal outcomes, and neuromodulation), a living guideline for evolving therapies and indications, and is focused on the use of neuraxial stimulation for the treatment of refractory pain. The selection of patients for implantation in those who have NSLBP should be based on published literature, best practice, and expert opinion. This NEURON project will allow for regular updates to create a living guideline that will allow for better assimilation of information to improve safety and efficacy going forward.

Scope: Management

Diseases/Conditions (MeSH)

D062187 - Spinal Cord Stimulation

D017116 - Low Back Pain

D062187 - Spinal Cord Stimulation

D017116 - Low Back Pain

Keywords: low back pain, lumbar degenerative disc disease, spinal cord stimulation

Inclusion Criteria: Male, Female, Adult, Older Adult

Health Care Settings: Ambulatory, Operating and Recovery Room, Outpatient

Intended Users: Nurse, Nurse Practitioner, Physician, Physician Assistant