- With millions of people still using opioids in the US to for pain relief, doctors and patients are looking for alternative pain treatments.
- Neuromodulation, an implanted device which applies controlled amounts of electricity into the nervous system to treat pain, offers an effective and scientifically-sound alternative to opioid use.
- The devices need to be installed in a surgery, and can only be used for some types of pain. Also, they can cost more than $US30,000.
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Amid the opioid-addiction epidemic, patients and doctors are hunting for new ways to treat pain.
One promising alternative is a 50-year-old treatment that uses small bursts of electricity to fight pain without drugs. The technology, known as neuromodulation, has been slow to catch on, because it can be costly and require surgery. Plus, it can only treat some types of pain.
One of the main types of neuromodulation is known as spinal-cord stimulation. About 110,000 neuromodulation devices for spinal cord stimulation were sold in the US last year, a Medtech 360 report shows. This is an increase from the 90,000 devices sold in 2017 and the report projects that 223,000 devices will be sold in 2027.
“This is an amazing therapy that not enough people, let alone doctors, know about,” said Dr. Corey Hunter, a New York physician who treats people in pain. “That’s why we need to keep the studies and research out there, so when people are sceptical we can show them the evidence to back up this therapy.”
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Abbott, which makes spinal-cord stimulation devices, says device technology has improved and research now shows the devices can be used for more types of pain.
A 2016 report found that more than 289 million opioid prescriptions written each year. The most recent data from the US Department of Health and Human Services said 11.4 million people misused prescription opioids in 2017 and the main reason for the opioid misuse was to treat pain. Around 36% received their pain medication from a healthcare provider.
Neuromodulation is effective, but only for certain patients
A neuromodulation device for spinal cord stimulation (SCS) is implanted by a surgeon. The procedure is considered relatively minor and patients usually leave the hospital the same day.
Dr. Joseph Solberg, a pain doctor and professor at Columbia University told Business Insider that neuromodulation works effectively in, “the correct patients with the correct diagnosis.”
The device can’t simply treat anyone who has chronic pain syndrome. Dr. Solberg said it’s most effective for people who experience complications after spine surgery, or complex regional pain syndrome – a chronic pain condition that affects a limb usually after surgery.
Several studies show the treatment holds promise. A long-term study of 102 patients showed that 68% experienced a significant reduction in their pain symptoms, and another randomised control trial of 100 patients with failed back surgery syndrome found that the treatment provided continuous pain relief over a 24 month period.
Abbott, the medical device company, also conducted a recent study for its new Proclaim XR device on 24 patients, with 100% experiencing pain relief . The data was presented at medical meetings and hasn’t yet been published in a medical journal.
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overnment agencies with alternatives to opioid use
Abbott’s device works by sending mild electrical pulses to change pain signals as they travel from the spinal cord to the brain. The implanted device connects wirelessly to a person’s smartphone, allowing them to control it.
The new device uses lower doses of spinal cord stimulation, to extend the battery life to 10 years, avoiding the need to recharge it frequently.
In May 2019, Abbott partnered with the National Institutes of Health (NIH) on neuroscience research. NIH is looking into alternative methods to curb the opioid crisis and their agenda included finding new technologies to treat opioid use disorders. Abbott is providing NIH with neuromodulation technology for research related to pain treatment and movement disorders.
Recent technological advancements in neuromodulation have led to increased awareness of the devices within the medical community and in the public sector, said Dr. Allen Burton, Abbott’s medical director of neuromodulation told Business Insider said.
“People learned of the therapy 10 to 15 years ago when it didn’t work that well,” he said. “But with new technologies, the market really responded to the device. There’s significant growth in the space for neuromodulation.”
Neuromodulation has been gaining traction, with a recent drop this year
But surgeries to install neuromodulation devices may be on the decline. UBS analysts estimated that the worldwide spinal cord stimulation market declined 2% in the second quarter of the year.
The UBS analysts said there are multiple reasons for the decline including lack of new product launches, turnover among sales representatives, and increased use of alternative pain treatments like CBD oil.
Despite the recent dip, doctors surveyed by UBS expect growth for spinal cord stimulation over time, especially as an alternative to spine surgery. The UBS analysts predicted device company Medtronic would gain the most market share going forward, with Boston Scientific in second place and Abbott in third.
Hunter, the pain physician who runs the Ainsworth Institute of Pain Management, told Business Insider that the devices can be expensive, depending on the types of coverage health insurers provide.
The total cost of implanting a spinal-cord stimulation system for people with Medicare can be roughly $US32,900, while the total cost for someone with Blue Cross Blue Shield insurance can be $US57,900, according to a 2009 study. The cost that any individual actually pays depends on his or her insurance.