Implantable Multifidus Stimulator
At Pain Specialists Australia, our highly experienced pain specialists have over a century of combined medical expertise and education from countries including Australia, the UK, and Hong Kong. We provide advanced therapies for people with refractory chronic mechanical low back pain, which is pain that persists despite physiotherapy, medications, injections, or even surgery.
One such treatment is the implantable multifidus stimulator, also called multifidus restorative neurostimulation or device.
This therapy doesn’t just manage pain. It aims to reactivate the deep spinal stabiliser muscle (multifidus), restoring stability and helping patients return to normal life. It doesn’t mask the pain but actually treats and restores the source of the pain.
The multifidus muscle is key to spinal stability and chronic low back pain.
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Why Choose Multifidus Restorative Neurostimulation?
Most back pain treatments only reduce symptoms temporarily. Medications, injections, and nerve blocks may help for weeks or months but rarely address the root cause. Patients often describe feeling trapped in a cycle of “short-term relief and back to square one”.
Targets the Root Cause - spinal stabiliser dysfunction
The multifidus muscle, a deep spinal stabiliser, often stops functioning properly in chronic low back pain. This leads to spinal instability and ongoing and worsening pain as well as worsening function. Restorative muscle stimulation retrains this muscle, addressing the root cause rather than just masking symptoms.
Minimally invasive, day procedure
The stimulator is implanted in a short, minimally invasive procedure, usually under sedation, anaesthetic. Most patients can return home the same day or following day.
Evidence-based relief and improved function
Clinical studies demonstrate sustained improvements in pain, mobility, and daily function over 2–5 years. Patients often describe the therapy as “life-changing”.
MRI comparison of multifidus muscle wasting versus healthy muscle; a key cause of chronic low back pain.
How Multifidus Muscle Restorative Stimulation Works
Implantation procedure & device setup
A small device is implanted under the skin with leads placed near the nerves controlling the multifidus muscle. The procedure is guided by imaging for precision and safety.
Patient-guided daily stimulation sessions
Using a handheld controller, patients run two daily 30-minute sessions of muscle stimulation. These sessions activate the multifidus muscle, retraining it like a targeted workout. Over time, this restores spinal stability and reduces pain.
X-ray image of an implanted multifidus stimulator device.
Who Might Benefit from Multifidus Restorative Neurostimulation?
1. People with Chronic Low Back Pain That Hasn’t Responded to Other Treatments
This therapy is designed for adults with refractory mechanical low back pain, meaning pain that persists even after trying standard care like:
Physiotherapy
Pain medications (including anti-inflammatories or nerve pain drugs)
Injections, nerve blocks or radiofrequency ablation
These are often patients who say: “I’ve tried everything and nothing works”.
They may also have what’s called Persistent Spinal Pain Syndrome ((PSPS) or previously called Failed Back Surgery Syndrome (FBSS), which is ongoing pain despite having spinal surgery.
2. People with Multifidus Muscle Dysfunction
Multifidus neurostimulation is not just for any kind of back pain. It specifically targets dysfunction in the multifidus muscle, a deep spinal stabiliser often overlooked in routine scans.
Clues that this therapy may be suitable include:
Clinical tests show poor or delayed activation of the multifidus muscle on one or both sides.
MRI or ultrasound imaging may reveal multifidus wasting (shrinkage) or fatty infiltration, even when no major disc or nerve problem is seen.
Patients are often told: “Your scans are normal,” yet still experience ongoing, disabling pain.
This mismatch between symptoms and standard imaging is often a red flag for functional muscle weakness rather than structural failure, and that’s exactly what this treatment aims to restore.
Testing for multifidus dysfunction helps identify patients who may benefit from restorative stimulation.
Clinical Evidence & Long-Term Results
Backed by Rigorous Research and Real-World Outcomes
Multifidus restorative neurostimulation isn’t experimental, it’s backed by high-quality clinical trials and long-term patient follow-up.
A landmark international study followed patients with chronic mechanical low back pain who had not responded to conventional treatments like physiotherapy, medications, or injections.
Key results at the 2-year mark:
Sustained reduction in pain scores
Improved functional ability (measured by validated disability indices)
Better overall quality of life, including sleep, mood, and movement
Unlike treatments that lose effect over time, this therapy showed continued improvement the longer patients used it.
5-Year Results: Long-Term Pain Relief and Functional Recovery
Long-term data from follow-up studies show powerful, lasting outcomes:
78% of patients achieved at least a 50% improvement in pain and/or disability
Many were able to reduce or stop opioids and other pain medications
Patients reported returning to daily tasks, work, social roles, and physical activity that had previously been out of reach
These aren’t just numbers, they reflect real-life gains: lifting children, walking the dog, getting back to hobbies, or simply sitting through a meal without pain.
Why This Matters
For patients who feel stuck, told there’s “nothing more that can be done”, this therapy offers evidence-based hope, especially when the root cause is multifidus dysfunction, not disc or nerve compression.
Safety Profile & Potential Risks
Multifidus restorative neurostimulation has shown a strong safety profile in clinical trials and long-term follow-up.
Low complication rate: Serious events occurred in fewer than 5% of patients.
Minor side effects: Some patients reported temporary discomfort at the implant site or mild overstimulation.
No lead migration: Unlike other spinal implants, lead movement has not been reported in published studies.
For patients who are fearful of another failed treatment, these results provide real reassurance. This is a therapy designed to be safe, well-tolerated, and reversible if needed.
Multifidus Stimulation vs Spinal Cord Stimulation
These two implantable treatments work in very different ways — and are used for different types of pain.
Multifidus restorative stimulation targets mechanical low back pain by restoring function to the deep stabilising muscles of the spine.
Spinal cord stimulation (SCS) is designed to reduce nerve-related (neuropathic) pain, such as sciatica, nerve injury, CRPS or pain after spinal surgery (PSPS or FBSS)
The right therapy depends on what’s driving your pain, muscle dysfunction vs nerve damage. A detailed assessment helps identify which approach is likely to work best. This should be done by experts such as one of our high experienced pain specialists.
Why Choose Pain Specialists Australia?
National leaders in interventional pain medicine – all specialists are appropriately qualified and selected. Our specialists have decades of expertise in diagnosing and treating this and many other complex pain conditions.
Expertise in complex pain – trusted by GPs, surgeons, and allied health professionals for more than a decade.
Cutting-edge procedures – including advanced radiofrequency ablation, image-guided injections, and neuromodulation therapies.
Patient-centred care – we listen, believe, and tailor treatments to your needs.
Convenient Melbourne locations – providing care across Melbourne. We have access to telehealth.
Frequently Asked Questions (FAQ)
1. Does this treatment fix the problem or just mask the pain?
Multifidus restorative neurostimulation is designed to retrain the multifidus muscle, which plays a key role in stabilising your lower back. Unlike treatments that simply block pain signals, this approach aims to restore healthy spinal function over time — treating the root cause, not just the symptoms.
2. How long before I see results?
Most patients experience gradual improvements within the first few weeks, particularly in pain, stability, or movement. These gains often continue to build over 3 to 6 months, especially when combined with guided rehab and physical activity.
3. Is a multifidus stimulator the same as a spinal cord stimulator (SCS)?
No. While both are implantable devices, they treat completely different types of pain.
Spinal cord stimulation is best for nerve-related (neuropathic) pain like sciatica or CRPS.
Multifidus stimulation is designed for mechanical low back pain caused by muscle dysfunction, especially when scans show no major disc or nerve issue.
4. Is it covered by private health insurance?
In many cases, yes, usually if you have Silver Plus or Gold Hospital cover. Coverage can vary between funds, so it’s best to check directly with your insurer. We can also help guide you through the process.
5. What are the risks?
Like any procedure, there are some risks, but they’re considered low overall.
Minor side effects may include temporary discomfort at the implant site or overstimulation.
Serious complications, such as infection, are rare and treatable.
Importantly, the device can be removed if needed.
Get Your Diagnosis by Our Melbourne Pain Specialists
Whether you’ve had pain for weeks or years, our team at Pain Specialists Australia can provide answers, advanced treatments, and renewed hope.
References
Further Reading and References on Implantable Multifidus Stimulation:
1. Gilligan C, Volschenk W, Russo M, et al. Five-Year Longitudinal Follow-Up of Restorative Neurostimulation Shows Durability of Effectiveness in Patients With Refractory Chronic Low Back Pain Associated With Multifidus Muscle Dysfunction. Neuromodulation. 2024 Jul;27(5):930-943.
- Five-year data confirms multifidus restorative neurostimulation provides durable pain relief and improved function in patients with chronic low back pain linked to muscle dysfunction.
https://pubmed.ncbi.nlm.nih.gov/38483366/
2. Ardeshiri A, Amann M, Thomson S, Gilligan CJ. Application of restorative neurostimulation for chronic mechanical low back pain in an older population with 2-year follow up. Reg Anesth Pain Med. 2025 Mar 5;50(3):231-236.
- Two-year follow-up shows restorative neurostimulation is safe and effective for chronic mechanical low back pain in older adults, with sustained improvements in pain and function.
https://pubmed.ncbi.nlm.nih.gov/38460963/
3. Cleveland Clinic. Implant reduces chronic back pain after eight years.
- Cleveland Clinic highlights a patient case where multifidus restorative neurostimulation provided lasting relief from chronic back pain after eight years of failed treatments.
4. Abd-Elsayed A, Kurt E, Kollenburg L, Hasoon J, Wahezi SE, Storlie NR. Lumbar Multifidus Dysfunction and Chronic Low Back Pain: Overview, Therapies, and an Update on the Evidence. Pain Pract. 2025 Jun;25(5):e70044.
- Comprehensive 2025 review confirms lumbar multifidus dysfunction as a key driver of chronic low back pain and supports restorative neurostimulation as an emerging evidence-based therapy.
https://pubmed.ncbi.nlm.nih.gov/40361257/
5. Schwab F, Mekhail N, Patel KV, et al. Restorative Neurostimulation Therapy Compared to Optimal Medical Management: A Randomized Evaluation (RESTORE) for the Treatment of Chronic Mechanical Low Back Pain due to Multifidus Dysfunction. Pain Ther. 2025 Feb;14(1):401-423.
- The 2025 RESTORE RCT shows restorative neurostimulation significantly outperforms optimal medical management for chronic mechanical low back pain caused by multifidus dysfunction.
