Media ReleaseFrom: International Neuromodulation Society
SYDNEY, Australia – Three patients, including a Sydney-area chronic pain patient, will share their personal experiences with neuromodulation therapy at a free public educational event taking place at the International Conference Centre – Sydney from 12:00 – 16:30 on Sunday, 26 May, 2019.
“Neurostimulation: An established drug-free therapy for chronic conditions that can improve quality of life” will be emceed by Dr Sally Cockburn, a GP and host of Talking Health on Melbourne radio 3AW. The free public educational event is being presented for patients, carers, healthcare providers, and the general public by the Neuromodulation Society of Australia (NSANZ) and New Zealand and the International Neuromodulation Society (INS). With NSANZ as local convener, the INS is holding its 14th World Congress in Sydney from 25 - 30 May, 2019. (Pre-registration for the free public event on 26 May 2019 is requested at bit.ly/Sydney-program)
At the public event, patient speakers from Australia and worldwide experts will present neuromodulation therapy for chronic pain, bladder dysfunction, and movement disorder such as Parkinson’s disease.
Chronic pain patient Dennis Shallis, 61, of Wingello NSW, will speak about his experience with one of the most common forms of neuromodulation therapy, a neurostimulation system that uses spinal cord stimulation. He says, “This treatment has enabled me to be more active, drive my vehicle, walk for longer periods, participate and be more involved in my chosen sport of long-range precision target shooting and assist around the house more. Since the treatment I have represented Australia in New Zealand in shooting contests and in various competitions around Australia. The treatment has improved my lifestyle and my relationships with my wife, family and friends.
“As soon as it was turned on, it gave me relief from the pain that I had. The biggest learning curve was that while it limited and in some cases stopped the pain, the injury was still there, so I couldn't do everything that I wanted. Using the controller is great as I can adjust the unit to suit my needs.”
He had been living with his injury for 30 years. “While I was serving in the Australian Army and returning from the day training exercise,” he explains, “I was standing in the turret of an Amour Personnel Vehicle, when it was driven into a culvert, causing an injury to my back.”
Over time the chronic pain became harder and harder to manage. His wife, a nurse at the time of his injury, had talked him out of having spinal fusion offered by the army. Instead, he tried bed rest, physiotherapy, traction, cortisone injections, dry acupuncture, chiropractic treatments / manipulations as well as treatment with a range of various analgesic and anti-inflammatory medications. With worsening symptoms, he eventually visited a spinal specialist about three years ago, who referred him to a pain management physician. He agreed to try spinal cord stimulation once they determined that a cortisone injection provided scant relief. He remarks, “the rest is history”.
He says the treatment initiated three years ago “has had a profound effect on my lifestyle and ability to participate in living, that is, I had become very depressed and felt worthless as I watched my wife do everything around the home and was not able to join in social activities. I was unable to sit or travel in a car for long periods, lift objects and could not exercise. In addition, I was finding it very hard to travel to and from work and to perform normal duties.”
A former security manager at the Australian Museum, he says he accepted a redundancy due to excessive leave due to increased pain, and now works casually as a range officer.
To learn more about the public event and view the program, visit https://www.neuromodulation.com/australia#public .
What Potential Patients and Referrers Should Know
Some 60 to 70% of patients who receive a spinal cord stimulator have had back surgery but continue to experience residual and persistent pain, according to Dr Marc Russo, director of Hunter Pain Clinic in Newcastle, NSW, who has authored patient information regarding this scenario. Dr Russo is chair of the International Neuromodulation Society 14th World Congress, and founding president of the Neuromodulation Society of Australia and New Zealand. He established Hunter Pain Clinic as the country’s first multidisciplinary private pain clinic in 1999.
“Typically,” he says about spinal cord stimulation, “perhaps two out of 100 patients may be suitable for this therapy.” In the past 15 years, he adds, trialing spinal cord stimulation has become somewhat routine for persistent pain that has failed to respond to other therapies, such as medication, physical therapy, psychological therapy, or simple interventional pain medicine techniques.
After a temporary spinal cord stimulation trial at home for about a week, a patient who has had a significant reduction in pain would be recommended to have a permanent system implanted – while being asked to acknowledge that pain will typically not be entirely eliminated. (In tandem with pain reduction, the treatment aims to also improve function, and thus, quality of life.) An appropriately selected and applied conventional system would typically yield a pain reduction between about 50 to 75%. Newer systems with refinements in stimulus dosing – a discussion topic for the upcoming scientific meeting – are advancing that may further optimize pain relief.
How Neuromodulation Works
As explained on the website of the International Neuromodulation Society, www.neuromodulation.com, neuromodulation was initially developed in the 1970s - 1980s and has evolved into a family of therapies that often use small implanted medical devices, powered in a similar fashion to a cardiac pacemaker. According to the INS, the therapies alter nerve activity through “targeted delivery of a stimulus, such as electrical stimulation or chemical agents, to specific neurological sites in the body.”
Neuromodulation works by either actively stimulating nerves to produce a natural biological response or by applying targeted pharmaceutical agents in tiny doses directly to site of action. Neurostimulation is delivered through electrical signals or other forms of energy.
Neuromodulation therapy may be considered for select patients, through a multidisciplinary assessment, either as an adjunct to other care, or when symptoms do not adequately respond to more conservative measures, for instance, when existing drugs are ineffective or become problematic for long-term use due to development of tolerance, addiction, adverse side-effects or toxicity.
The therapy provides an additional means of managing symptoms of chronic conditions that have a neurological basis, for instance, to decrease neuropathic pain, spasticity, epileptic seizures or migraine, or tremor and stiffness from degenerative movement disorder, or restore some function, such as a cochlear implant for hearing or sacral nerve stimulation for urinary incontinence and other pelvic disorders. In the case of pharmacological agents delivered through implanted pumps, the drug can be administered in smaller doses because it does not have to be metabolized and pass through the body before reaching the target area. Smaller doses—in the range of 1/300 of an oral dose—can mean fewer side effects, increased patient comfort and improved quality of life.
Whether the devices are implanted or external, neurostimulation therapies can help reestablish neural balance, similar to the way a cardiac pacemaker or defibrillator corrects heartbeat abnormalities. Transcranial magnetic stimulation, for example, is a non-invasive form of neuromodulation that has found application in acute migraine treatment and treatment for medication-resistant clinical depression. (Transcranial magnetic stimulation will be the subject of the first preconference on 25 May, 2019, during the INS 14th World Congress.)
The application of functional electrical stimulation (FES) had its origins in the management of spinal injury and post-stroke care. A number of external and implantable devices have been designed and manufactured to restore useful function in an otherwise intact nervous system. Applications and outcome aims range from a method of enhancing physical rehabilitation after such an injury to the restoration of upper and lower limb function, bladder function and chest ventilation after complete spinal cord injury.
Most frequently, people think of neuromodulation in the context of chronic pain relief, the most common indication; neuropathic pain affects about 8% of the population and accounts for 30 - 65% of the activity seen at hospital pain clinics. Neuromodulation is often an invasive treatment but for selected patients whose chronic conditions cause suffering and disability it can bring considerable relief and improvement, often after all other measures have failed. Despite their technological complexity, several studies indicate that for some patients, early use of neuromodulation technologies may be more cost effective at controlling certain conditions overall than medical management approaches.
Providers of such therapies include neurosurgeons, pain physician specialists and rehabilitation physicians. They may often work with other specialists such as neurologists, psychiatrists, psychologists, gastrointestinal or colorectal specialists, urologists, primary care physicians, and physical therapists to achieve best outcomes.
As reflected in the breadth of knowledge presented during the International Neuromodulation Society biennial world congress and in its peer-review journal Neuromodulation: Technology at the Neural Interface, advances in neuromodulation therapies are truly multi-disciplinary, requiring the close collaboration of neuroscientists, engineers and clinicians to reach fruition.