- Chronic pain is a condition that affects millions of Americans.
- The standard way to treat it is by using opioid painkillers. But in recent years, especially as the opioid epidemic continues to hit the US, doctors and patients are looking for alternatives.
- One alternative is neuromodulation, a treatment that sends electrical signals to certain nerves in the body to treat pain.
Chronic pain, characterised by pain lasting more than 12 weeks, is a debilitating condition that affects millions of Americans.
And a high number of people living with chronic back pain take opioids to treat the pain. It’s led to a large amount of overlap between chronic pain diagnoses and diagnoses of opioid use abuse, data from Amino a consumer healthcare company, found.
For decades, the standard has been to treat chronic pain with potent opioids, though in recent years there has been a bigger push toward alternatives.
Those, however, can be more expensive for patients, in part because insurers aren’t as willing to pay for the alternatives over opioids, as Business Insider’s Harrison Jacobs reported last year.
Even so, some doctors and patients are turning to neuromodulation, a therapy that uses a medical device to treat pain, as an alternative to opioids. The approach has been around for decades, but in the past few years new technology has been developed that makes the devices more precise at targeting pain.
Abbott Laboratories, a healthcare company that produces everything from meal replacement shakes to blood sugar monitors, has its own line of neuromodulation devices after acquiring medical device company St. Jude Medical earlier this year.
Allen Burton, the company’s medical director of neuromodulation told Business Insider that there’s been a “perfect storm” of technological developments related to the treatment in the past few years alongside the exploding opioid epidemic that has opened the possiblity to make it more widespread and used earlier to treat pain than it is today.
Here’s how it works:
Neuromodulation devices send electrical signals to certain nerves in the body, thus creating interference that overrides the nerves from signalling pain to the brain.
For back pain, that means stimulating part of the spine, a process known as spinal cord stimulation. But back pain is far from the only pain that can be treated with neuromodulation. Spinal cord stimulation, along with dorsal root ganglion stimulation can be used to send electrical signals to the arms, legs, hip, knees, and feet.
For a patient to recieve the therapy, he or she must undergo a procedure in which electrical leads are inserted into the body. From there, the leads link up with a battery that can either be inside the body or outside, depending on the device.
A patient is then able to control the battery and the signals it transmits via an external device. For example, with Abbott’s device, it’s connected to an iPad, from which you can control the implanted battery.
Prior to recieving the implant, Burton explained, patients get a patch that allows them to simulate how the device might feel. That way, if it’s not for them, they can choose not to proceed.
No longer a ‘last resort’
In 2016, about 34,000 people underwent spinal cord stimulation around the world. For now, the majority of people get the implants after failing other treatments and back surgeries. Ideally, Burton said, the hope is to bring it up so it could be used, possibly before people even use opioids.
There’s even some evidence, from a study run by Abbott researchers, that using the devices sooner rather than later could decrease opioid use and healthcare costs.
Abbott also found in a study that for the 5,400 patients who received spinal cord stimulation therapy, their opioid use stabilised or declined in 70% of the patients, compared to their use of the drugs before getting the treatment.
Many pain specialists have also touted the benefits of neurmodulation as an alternative to opioids.
“It should not be a last-resort therapy. In some patients, it should be the first choice,” Dr. Nagy Mekhail, a pain physician at the Cleveland Clinic told MIT Technology Review.
Dr. Timothy Deer, now the cochair of West Virginia’s Expert Pain Management Panel, has noted the benefits of the procedure in cutting down opioid use and reducing not just pain but costs in the long run.
“Evidence suggests that this technique can reduce the need for opioids, reduce pain, improve quality of life and reduce healthcare utilization and costs,” Deer wrote in a 2014 journal editorial.
Dr. Richard Vaglienti, the director of West Virginia University’s Pain Management Center and Deer’s cochair, told Business Insider that the treatments are moving up from “last resort” to “later resort.”
That may soon be enough to sway health insurers to cover the procedure sooner, which can be costly. Insurers and healthcare providers have been looking for new ways to curb prescription opioid use, including cutting the number of pills they prescribe in a year, and by no longer covering OxyContin, the branded version of the painkiller oxycodone.
Insurers and healthcare providers have often shied away from using neuromodulation due to its high cost. But Vaglienti, who has been using neuromodulation to treat patients with chronic pain for almost three decades, said that while opioids may appear cheap in comparison, their cost rises exceptionally if a patient becomes addicted and requires long-term addiction treatment in a clinic.
Vaglienti said that he’s seen insurers in West Virginia be more sensitive to testing out other alternatives to opioids, despite the higher cost.
Even so, covering neuromodulation is still on a case-by-case basis, according to America’s Health Insurance Plans, which represents health insurance companies,
“Treating pain is not a one-size-fits-all solution. It’s important to ensure patients are getting the quality, evidence-based care that best fits their need for pain management,” AHIP communications director Cathryn Donaldson said in an emailed statement.
“The therapy you mention below may be appropriate for a select group of patients. However, every patient is different and experiences pain differently, so there is a time and a place when opioids, or other therapies, are appropriate.”
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