1417 - External Pelvic Floor Electrical Stimulation for Chronic Low Back Pain: a novel case

A case of chronic low back pain (LBP) coincident with pelvic floor weakness that improved with treatment of the pelvic floor via a novel modality, external pelvic floor electrical stimulation (PFES).

Case Description:

A 55-year-old woman with 3 years of LBP (baseline 8/10) and MRI evidence of L4–5 and L5–S1 spondylosis had little relief from physical therapy, lifestyle modification, relative rest, and analgesics, asked to be a candidate for spine injection. While we were doing the workup for her spondylosis, she independently found and trialed an over-the-counter external silicone-seat pelvic floor electrical stimulation (PFES) device for 20 minutes daily. After three weeks, pain decreased from 8/10 to 2/10 with improved activity tolerance. With ongoing PFES three times weekly, improvements were sustained over three months. No adverse events were reported. She successfully avoided any invasive treatment, including spinal injections.

Discussions:

Emerging studies suggest PFES may influence lumbopelvic stability and spinal load sharing. Dysfunction of this system has been implicated in LBP. Pelvic floor muscle training and neuromuscular electrical stimulation are established for incontinence and postpartum care, with emerging links to LBP reduction. No randomized studies to date have evaluated external PFES for chronic LBP. This case suggests PFES may enhance deep core activation, proprioception, and pain control. This may be specific to female seniors or a broader population. Limitations include a single-patient design and a lack of standardized disability metrics.

Conclusions:

External PFES may represent a safe, feasible, and novel adjunct for chronic LBP associated with pelvic floor weakness. This case supports further investigation through controlled trials to assess efficacy, define optimal protocols, and identify responders.