Dr Vivek Mehta
Consultant in Pain Medicine and Neuromodulation at St Bartholomew’s Hospital
Dr Vivek Mehta, consultant in pain medicine and neuromodulation, discusses spinal stimulation and tells us which patients are suitable for this newly personalised treatment.
Treatment of pain is changing
“Spinal cord stimulation should be used earlier in pain management than it is at the moment,” says Dr Vivek Mehta, consultant in pain medicine and neuromodulation at St Bartholomew’s Hospital. He explains how patients are chosen for a trial of spinal cord stimulation (SCS). Patients who would be suitable for SCS have typically had pain for a long time, often years. Crucially, the pain is neuropathic (nerve pain), which can present itself with symptoms such as burning or pain arising from a very light touch. They have either had unsuccessful surgery, or are not suitable for surgery. They may have seen their local pain clinic and may have been treated with a variety of tablets for neuropathic pain, all of which have not worked. Many will have also been through a lengthy period of rehabilitation or a full pain management programme.
Careful assessment is important
Dr Mehta explains that patients with pain need a comprehensive assessment. Previous history will be reviewed, including what treatments have been tried and failed. All patients will also see a psychologist to be assessed as to their suitability for the treatment, as they need to be able to engage with it over a long period of time. By the time a patient reaches Dr Mehta, their journey through various past treatments may have taken years. He is keen to see SCS become an earlier option and points out that it has been approved by NICE for use in patients with chronic neuropathic pain. NICE’s most recent guidance on back pain does not recommend spinal fusion (a surgery previously done for chronic pain) and so SCS should now be able to move up the pathway of management for these patients. Working with NHS England, Dr Mehta is trying to make this happen in CCGs across the country.
Having control over their pain can enhance and change every aspect of a patient’s life.
Dr Mehta is excited about the new generation of devices, which allow personalisation of the neuromodulation, which is delivered to the patient. Waveform automation and combination therapy can allow the patient to target the treatment to the pain. Dr Mehta used the example of a patient with pain in the back that also radiates down to the foot. Their device could be set up with several programmes and the patient could choose which programme to use, depending on whether the back or foot pain was more prominent that day.
Controlling pain has wide benefits
If a patient has their pain controlled, they are more likely to stay active and therefore less likely to develop obesity and other problems associated with inactivity. They may be able to go back to work and are also likely to have psychological benefits from not being in pain. Having control over their pain can enhance and change every aspect of a patient’s life.