Dr Ashish Gulve
President, Neuromodulation Society of UK & Ireland
Honorary Treasurer, British Pain Society
Consultant in Pain Management, James Cook University Hospital, Middlesbrough, United Kingdom
Despite the availability of effective treatment options, neuropathic pain often remains untreated. Patient and healthcare provider awareness is essential to access these therapies.
Chronic pain is a major cause of disability worldwide. Neuropathic pain is a type of pain caused by an injury or disease of the nervous system. One in 10 people have neuropathic pain and almost half fail to get adequate pain relief with medications.
There is growing awareness and concern about the addictive potential of opioids and gabapentinoids. In 2008, the National Institute of Health and Care Excellence (NICE) recommended spinal cord stimulation (SCS) for routine use as an effective and cost-effective treatment for severe refractory neuropathic pain. Despite the guidelines, less than 1% of people with neuropathic pain receive an SCS therapy in the UK.
Benefits of spinal cord stimulation
Clinical trials and patient registries, such as the UK National Neuromodulation Registry, have shown significant improvement in pain, quality of life and reduction in medication following SCS implants. In UK practice, 75% of patients get at least 50% improvement in pain. As a consequence, they are able to reduce their opioids and gabapentinoid medications.
One in 10 people have neuropathic pain and almost half fail to get adequate pain relief with medications.
Improvement in quality of life
There are many causes of neuropathic pain. Persistent spinal pain syndrome (PSPS), where patients experience severe back and/or leg pain despite technically successful spinal surgery, affects more than 5,000 patients in the United Kingdom each year. There are 21,000 people who suffer from painful diabetic neuropathy in the UK and numbers are increasing.
Complex regional pain syndrome (CRPS) is a debilitating, painful condition in a limb that can result in severe disability and suffering. CRPS commonly arises after injury to that limb. However, there is no relationship to the severity of trauma, and in some cases there is no precipitating trauma at all (9%). Clinical trials have shown that early spinal cord stimulation treatment can improve pain, rehabilitation and function in these patients.
Cancer will affect one in two of us, and both the cancer itself and its treatment commonly cause pain. Despite the excellent palliative care in the UK, one in four patients have unrelieved or partially relieved pain. Uncontrolled pain and side effects of oral or injected pain killers can significantly reduce quality of life for these patients. The NHS funds highly specialised treatments such as continuous infusion of medications in the spine via an implanted pump to alleviate this pain.
The uses of neuromodulation are wide ranging and expanding. It is set to become a far more common treatment in the future. Patients and healthcare professionals need to access these treatment options in a timely manner.
