Dr Ganesan Barani
Consultant in Anaesthesia and Pain Medicine
Leeds Teaching Hospitals NHS Trust
Honorary Clinical Associate Professor, University of Leeds
Spinal cord stimulation therapy can reduce chronic neuropathic pain in some patients. Yet not everyone who might benefit from it is being treated.
Electrical stimulation to reduce chronic pain isn’t new, notes Dr Ganesan Barani, Consultant at Leeds Teaching Hospitals. In fact, it’s centuries old. “In 46AD, people would tie electric eels onto their heads if they had migraines, or stand on electric eels if they had sciatica,” he says.
Thankfully, electrical stimulation is rather more sophisticated these days. Take spinal cord stimulation (SCS), which has been routinely used for decades to treat patients who suffer from chronic neuropathic (or nerve) pain caused by accident, injury or disease. With SCS, a small device is placed under the skin. This delivers a mild charge to nerves along the spinal cord, which modulates the pain signals going to the brain.
“Neuropathic pain presents as a stinging, shooting or burning or pins and needles,” explains Dr Baranidharan. “If you have a back operation but your sciatica still persists, or you recover from shingles but still experience pain, or any surgery and have pain in the scar area, you may be a candidate for this treatment.” However, SCS does not work for patients with non-neuropathic pain.
Meeting an unmet need for chronic pain patients
Dr Barani — who is also President of the Neuromodulation Society of UK and Ireland (NSUKI) — believes that SCS could help many more neuropathic pain patients than it currently does. “For every 100 patients who could be offered SCS, we are only reaching out to around four or five of them,” he says.
If you have a back operation but your sciatica still persists, or you recover from shingles but still experience pain, or any surgery and have pain in the scar area, you may be a candidate for this treatment.
“There is a huge unmet need. We’ve told medical teams to send us their nerve pain patients, but our implant numbers have not risen over the years. So now we want to reach out to the patients themselves.” European expert group has developed an online tool (scstool.org; used by both doctors and patients) to reveal those individuals who may be suitable for SCS therapy and those who may not be.”
It’s never too late to seek SCS treatment. “I implanted a patient yesterday who had been in pain for the last 25 years,” says Dr Ganesan Barani. “Although the SCS implant is not 100% guaranteed to help — no intervention can promise that — we find that seven out of ten patients do benefit from it. Of those seven, two will have significant reduction in their pain and perhaps no pain at all. Two to three will have 50% pain relief. Two to three will have less than 50% pain relief, but still report that their pain is better compared to what it was before, and their quality of life has improved.”