Dr Ganesan Baranidharan, consultant in anaesthesia and pain medicine at the Leeds Teaching Hospitals NHS Trust, explains the power of neuromodulation for managing chronic pain and explains why comprehensive evidence is needed
A study in the British Medical Journal estimates that up to 48% of UK adults could be living with chronic pain. Most are prescribed opioids to help manage it and there are now reports of a 400% increase in opioid prescription in the UK. This is despite the fact that they have been proven to be ineffective in producing long term relief to patients’ suffering. Opioid aware is a very useful resource to get more information about the use of opioids in managing chronic pain.
there are now reports of a 400% increase in opioid prescription in the UK.
Chronic pain can go hand in hand with over dependency, which can lead to misuse. The US is currently battling an opioid crisis and recent findings show the UK could be on course to follow the same trajectory, which could have serious consequences not only for public health, but for the economy and society.
There is an alternative.
Neuromodulation is a highly targeted treatment used to reach specific areas within the body to reduce pain. In the majority of cases, a medical device is implanted directly in to the problem area and either works by stimulating the nerves to produce the body’s own natural response, or by emitting small amounts of analgesia.
In addition, the same technology can be used to treat many conditions from spinal injuries to Parkinson’s and bladder and bowel disfunction.
The huge advantage is the ability to target the therapy to the individual patient and the reversibility if it fails. It can dramatically improve people’s quality of life and comprehensive evidence is now needed to show its effectiveness, so more people can benefit from this alternative to popping pills.
The technology is evolving at a rapid pace and since neuromodulation has such a broad therapeutic scope, the time is right to gather the data. This would help form an even richer picture of how the implants can work across the patient spectrum, to improve access and enhance patient care.
A national picture
The importance of having a registry to monitor and track medical devices is now widely accepted as the best way to safeguard patient safety. Essential information is collected to monitor the devices’ performance in the real world and to trigger a first alert if a problem is identified.
Two years ago, the National Neuromodulation Registry (NNR) was established by the Neuromodulation Society of UK and Ireland (NSKUI) and is helping foster transparency and accountability across the specialism. The centrally held database, run by Northgate Public Services, benchmarks the efficacy of the devices and treatments being used. Hospitals, clinicians and manufacturers leverage the data to provide valuable insight which helps them to improve performance and best practice.
Fostering transparency and accountability
Before the NNR, there was no effective way to evaluate if an implant offered value for money. Now it is possible for the NHS to review the data to see if a treatment would be beneficial, based on cost, alongside details of reported complications and predicted outcomes. Clinicians no longer need to rely on anecdotal or manufacturer evidence to compare the effectiveness and cost of the treatment with more traditional pain management therapies.
The data also allows surgeons to compare their procedures against their peers, which helps them to learn from their own experience but also from that of others. The NHS can also target resources better by mapping out which implants are working best, the optimum time to implant them and which patient characteristics determine significantly improved outcomes.
NHS Trusts can compare the success rate of their surgeons, the device used and patient characteristics and cross reference the data against the national picture. This helps increase transparency and accountability and inform best practice, underpinning patient safety.
Increasing patient access
Exploring a range of pain management therapies is a must if we are to avert a new public health crisis, whilst improving the quality of life for those suffering with debilitating chronic pain.
The significant advancements in neuromodulation technologies over the last four to five years means it is now a serious contender for treating persistent pain and improving the health and wellbeing of patients. And yet most people will not have heard of it. In the UK only a fraction of those, about 5%, who could be benefitting from the treatment are doing so.
Targeted, effective pain management can have a dramatic effect on people’s lives, from the lower end of the scale, reducing medication or improving sleep, to the higher end – where the transformation is so great that a patient could take up rock climbing after years of struggling with pain.
A growing need
If chronic pain is not managed correctly, the cost extends beyond the individual with wider repercussions for the health sector and the communities it serves. Reports estimate that 28 million people in the UK are suffering from chronic pain which accounts for 4.6 million doctor’s appointments and 10 million sick days being taken for back pain alone.
The Neuromodulation Registry is helping to bridge the critical gap between what we know about a device when it first comes to market and how it performs in real world scenarios. Gathering this evidence will be essential for bringing relief to the many, rather than the few.
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