The Case for Spinal Cord Stimulation in Chronic Pain March 10, 2017

Expert physicians gathered in a round table event to discuss Spinal Cord Stimulation as a treatment for chronic pain.

Background

With opioid abuse posing a national health crisis, the American College of Physicians recently issued a new guideline to promote treatment alternatives like acupuncture and yoga ahead of opioids on the treatment continuum for low back pain. But, many pain specialists believe alternative therapies like these don’t provide adequate symptom relief, leaving patients to look toward opioids as their only option.

A group of the nation’s leading experts in spinal cord stimulation (SCS) convened for a roundtable discussion at the 2017 North American Neuromodulation Society Annual Meeting to discuss why SCS should be used earlier in the treatment continuum and how it can play a role in addressing the ongoing opioid epidemic.

What becomes immediately apparent on reading the executive summary from the discussion, is that all 6 participants shared the view that SCS should play a much greater role in the management of chronic pain. There was unanimity of opinion that opioid use is problematic, carrying risks of misuse and abuse, while also only being “50% effective in 30% of patients treated.”

Management of patients off their opiates is of course another problem for the clinician, withdrawal being a weaning process and requiring an educational approach. The consensus seemed to be that SCS should be positioned ahead of opiates in the pain treatment continuum.

So why isn’t that already the case? Well it seems that the early days of the therapy weren’t quite as successful as today, which may have spawned resistance in both the clinical and patient community. The panel took this subject on too, suggesting that older technologies presented difficulties targeting specific nerves, while today’s is considered “not the same therapy” and “capable of yielding 100% pain relief.”

The final topic was the SCS patient pathway, the group concluding that the subjective nature of current pain scoring methods meant that their use should not be the only factor. The group expressed a desire to work with medical societies and regulatory bodies to develop a more nuanced standard for measuring patient outcomes.

Selected Physician comments

Dr. Mark Wallace, chair of the division of Pain Medicine in the Department of Anesthesiology of University of California at San Diego stated; “In my 25 years’ experience, all of my patients reduced their opiates once I put a spinal cord stimulator in them. Most of them completely go off of the opiates. So what we need to do is we need to position the neuromodulations before opiates, and we need to change the pain treatment continuum and get it earlier in the treatment continuum so we can keep patients from starting the opioids in the first place.”

On the subject of the modern SCS therapies, Dr Julie Pilitsis, professor of neurosurgery and of neuroscience at Albany Medical College and Chair of the Department of Neuroscience and Experimental Therapeutic, stated; “I would just like to encourage people…that may have had a negative experience with spinal cord stimulation 20 or 30 years ago to come back to the therapy. It is not the same therapy. We have so many more capabilities. We can help so many more people.”

On the need for a new approach to scoring patients for pain levels, Dr Simon Thomson, consultant in pain medicine and neuromodulation at Basildon and Thurrock University NHS Trust, UK, stated; “I think most people would say in something like chronic pain, it’s plainly ridiculous just to have linear pain scores to define, if you like, the suffering that this patient and those around them are going through … the measure that seems to best define what we’re looking at achieving in our patients is a health-related quality of life measure.”

Source: Boston Scientific


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