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What are the next steps in chronic pain relief?

What are the next steps in chronic pain relief?

It is estimated that 1.2 billion adults globally suffer from chronic pain, impacting on their quality of life and capacity to go about their day to day activities. While some patients find relief from conservative treatments, what happens when these treatments aren’t enough or prove ineffective for the patient?

Neuromodulation can be the life-changing step in providing relief for these patients. Neuromodulation is the ‘modulation’, or the process of altering ‘neural’ (or nerve) activity by delivering electrical currents to interrupt pain signals on their pathway to the brain. This is achieved by a neuromodulation device which consists of precisely placed leads connected to a power source.

Here are 8 things to know about neuromodulation:

1. Neuromodulation aims to alleviate or lessen pain without the ‘brain fog’ that sometimes result from opioids.
Neuromodulation is a therapy aiming to relieve pain with neuro-stimulation, enabling patients to avoid brain fog side effects associated with opioids or excessive sedation. These side effects include clouding of thoughts, fatigue, forgetfulness, lack of concentration or inability to focus.

2. Potential neuromodulation patients can test the treatment to see if its right for them.
Neuromodulation is administered in two stages: a trial stage and an implant stage. The temporary trial stage consists of a needle-based approach through which the leads of the device are inserted. This allows the patient to test the therapy before final consideration of the device’s implantation.

3. Neuromodulation is an evidence-based therapy that has shown to decrease chronic pain and improve quality of life for some patients.
Approximately 1.2 billion adults are affected by chronic pain globally—more than the total affected by heart disease, cancer, and diabetes combined. Pain can affect an individual’s ability to function and even perform the simplest of activities of normal living.
Many studies and clinical trials have documented neuromodulations ability to decrease chronic pain in patients, thus improving their quality of life. Studies show that neuromodulation can halve your pain [1,2], with those experiencing foot pain achieving average pain reductions of 80% [1,2]. Additionally, measures of quality of life (such as the ability to sit, walk and stand) were improved and patients reported high levels of satisfaction after implantation.

4. It is a low risk procedure and has been used in practice for over half a century.
Extensive research and clinical trials have shown neuromodulation to be a low risk treatment. With the modern era of neuromodulation beginning in the 1960’s, neuromodulation has been highly practiced, improved and researched, resulting in the highly modernized and low risk procedure provided today. A study assessing the safety of devices over the course of a year found no serious adverse events related to devices [3] with minor complications reversible and usually resolved [2]. Neuromodulation devices are also approved by the Australian Government Department of Health’s Therapeutic Goods Administration (TGA) regulatory body.

5. Neuromodulation devices can be programmed to optimise pain relief
Neuromodulation devices can be programmed by manipulating amplitude, pulse width and frequency of electrical stimuli in order to optimise pain relief in patients. Modern devices allow patients to program their own devices and gives the ability for them to be switched on or off. It is highly recommended for the patient to check with their pain practitioner before making any changes to their programming to optimise pain relief.

6. Neuromodulation can be applied through different techniques.
Neuromodulation comprises of multiple treatment modalities including spinal cord stimulation (SCS), dorsal root ganglion (DRG) stimulation, sacral stimulation, peripheral nerve stimulation (PNS) and peripheral nerve field stimulation.

7. Neuromodulation implants can be removed.
Even if a patient chooses to proceed with the second stage of neuromodulation after a successful trial, the device can still be removed if the patient chooses to stop treatment.

8. In Australia, neuromodulation procedures are covered by most gold cover private health insurance.
As with all medical procedures, the patient must check with their insurance plan to receive proper approvals.

 


References:
[1] Liem, L., Russo, M., Huygen, F.J., Van Buyten, J.P., Smet, I., Verrills, P., Cousins, M., Brooker, C., Levy, R., Deer, T. and Kramer, J., 2015. One‐year outcomes of spinal cord stimulation of the dorsal root ganglion in the treatment of chronic neuropathic pain. Neuromodulation: Technology at the Neural Interface, 18(1), pp.41-49.

[2] Verrills, P., Sinclair, C. and Barnard, A., 2016. A review of spinal cord stimulation systems for chronic pain. Journal of pain research, 9, p.481.

[3] Deer, T., Pope, J., Benyamin, R., Vallejo, R., Friedman, A., Caraway, D., Staats, P., Grigsby, E., Porter McRoberts, W., McJunkin, T. and Shubin, R., 2016. Prospective, multicenter, randomized, double‐blinded, partial crossover study to assess the safety and efficacy of the novel neuromodulation system in the treatment of patients with chronic pain of peripheral nerve origin. Neuromodulation: Technology at the Neural Interface, 19(1), pp.91-100.

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