Recent developments have brought about some meaningful advances in the field of interventional pain management in the form of new technologies. While the use of pain medications is slowing, more and more technology is able to fill the gaps.
Cleveland Clinic pain management specialist Robert Bolash, MD, says, “A number of therapies are achieving much more than modest pain reduction in the rating scale for pain intensity that patients have become accustomed to – the zero to 10 pain scale.”
A recent clinical trial looked at a new form of spinal cord stimulation (SCS) and found that chronic pain was reduced for patients. The new SCS was compared with conventional SCS in patients with back and leg pain caused by common spine pain diagnoses, including failed back syndrome, nerve root pain (radiculopathy) and degenerative disk disease.
In the trial, two-thirds of patients with chronic spine pain achieved a major reduction in their pain with the new SCS, while just 35 to 40 percent had less pain with the conventional device. Follow-up two years later showed the same results. A change in the way the device is programmed is likely the reason for this significant advancement in chronic pain care. “The new device improved pain and allowed the patients to better enjoy work, hobbies and other aspects of life,” says Dr. Bolash. This new device is currently being used in patient care.
Complex regional pain syndrome (CRPS) is a challenging pain condition. A recent clinical trial of a new type of neuromodulation device may advance the treatment model for patients. Standard practice calls for dorsal column stimulation, but the new device was applied to the dorsal root ganglion (DRG) near the spinal nerve. This led to 70 percent of patients achieving an 80 percent decrease in pain, compared to 52 percent with conventional SCS. “This new placement may also help to conserve battery life,” says Dr. Bolash.
One concern with these advances is battery technology, which continues to lag behind the rapid evolution of hardware devices in healthcare (and elsewhere). “Batteries are still big and cumbersome so physicians are looking at wireless devices,” says Dr. Bolash.
Wireless power is now being used in smartphones. And the elimination of a separate pulse generator has recently been seen in cardiac care with an entirely self-contained pacemaker, which can be implanted in the heart.
Dr. Robert Bolash says pain doctors are optimistic about these advances but are looking at the long-term outcomes based on safety, effectiveness and costs. The hope is that these technologies will help a wider range of nerve pain disorders such as diabetic neuropathy, post-herpetic neuropathy, phantom limb pain/stump pain after amputation, and potentially even central neuropathic pain disorders.
The good news is that well-designed and meaningful clinical trials are currently being carried out, which can provide immediate benefit to patients.
“I don’t measure success in treating pain as a decrease in intensity on a zero to 10 scale,” says Dr. Bolash. “I look at what patients can do as a result of my treatments. That might mean walking farther at the mall without needing to sit down or beginning to attend their grandson’s baseball games because they are not burdened by pain.”
He adds. “We still have a way to go in treating pain, but I am hopeful that technology may play a role in allowing patients to achieve pain relief.”