Pain Management Specialists -  - Board Certified Interventional Pain Management Physician

Pain Management Specialists

Board Certified Interventional Pain Management Physicians located in Rockville, MD & Frederick, MD

When you continue to suffer from ongoing, debilitating low back pain despite conventional treatment, it’s time to consider Reactiv8. Stuart Hough, MD, and Ramani Peruvemba, MD, at Pain Management Specialists in Rockville and Frederick, Maryland, have helped many patients find relief from pain with the latest innovative technologies. To learn whether you’re a good candidate for Reactiv8, schedule an appointment online or call one of the offices today.

This video explains how neuromuscular inhibition causes back pain.

What is Reactiv8?

Some people will develop chronic low back pain after an injury due to a process called neuromuscular inhibition. In these patients, the pain itself triggers a vicious cycle of muscle disuse, weakness, spinal instability and more pain. People with this condition are unable to recover effectively with physical therapy and have physical exam and MRI findings consistent with multifidus muscle atrophy.

Multifidus muscle atrophy as seen on MRI (from Mainstay Medical):

Reactiv8 is a novel implanted device that uses mild electrical impulses to strengthen the multifidus muscles in the lower back. The Reactiv8 device ( is the first of its kind “restorative” neurostimulator for pain. Unlike peripheral nerve and spinal cord stimulators (, which treat pain by altering the way the nervous system processes pain signals, Reactiv8 actually treats the underlying problem. As with traditional forms of exercise, it takes several months to show full benefit. Once the back pain has resolved, Reactiv8 can be removed in a second minor procedure.

The Reactiv8 Device (from Mainstay Medical):


What happens during the Reactiv8 Procedure?

Your Pain Management Specialists doctor performs Reactiv8 implantation in an outpatient surgery center or hospital operating room under general anesthesia or with deep sedation.The procedure typically takes about an hour. During the procedure, you are given anesthesia, then positioned on your stomach. The skin is cleaned and an intravenous antibiotic is administered to prevent infection.

Next, your doctor makes a small incision in the middle of your lower back and inserts two needles using X-ray guidance. After precisely positioning the needles next to the L3 transverse processes (the small bone “wings” that extend from the side of the L3 vertebra) stimulating electrodes are inserted and secured in place next to the nerves that control the left and right multifidus muscles. Next, the electrodes are connected to a battery powered pulse generator, which is then implanted under the skin in the lower back or buttock area. After your Reactiv8 procedure, you will need to spend a short time in the recovery room before going home. You must arrange to have someone drive you home after the procedure.

When will I feel pain relief after the Reactiv8 Procedure?

Pain from the Reactiv8 procedure is usually mild and temporary. After a couple of weeks, the Reactiv8 device will be activated. Treatment then consists of two 30 minute sessions of muscle stimulation daily. Most patients do this while doing something sedentary, like reading a book or watching TV. Reactiv8 patients typically start to experience relief of their usual low back pain between two and six months after the procedure, and most will experience at least 50% relief within a year.

The Pain Management Specialists team has witnessed remarkable advances in the treatment of lower back pain in the last few years and has been on the forefront of offering the latest proven treatments to patients. They are among very few interventional pain management practices in the area trained to evaluate and treat patients with the Reactiv8 device. If you’re ready to get pain relief using Reactiv8, call Pain Management Specialists or schedule an appointment online today.