A new solution to managing chronic pain offers long-term relief
Posted on 12 September 2019
Pain is a daily challenge that many people have to contend with. When it is a chronic condition, this can drastically affect the patient’s quality of life. Dr Andries Oberholzer is a physician based at Mediclinic Potchefstroom and supports patients suffering from chronic pain. He now has a new weapon in the fight to reduce the impact of pain on his patients.
In a first for South Africa, the Stimwave Freedom Spinal Cord Stimulator (SCS) is providing relief with the touch of a button. The programme can be loaded on a smartphone, which is then linked to a neuromodulation device implanted inside the body. This allows pain sufferers to fine tune the power level, visualise battery life and modify programmes to control pain without the use of strong medication.
“The Stimwave’s stimulators are implanted as an outpatient procedure without the need for general anaesthesia, large incisions or a bulky internal battery,” explains Dr Oberholzer. “My patients now have the option to reduce the lifetime cost of managing chronic pain with a safe, viable and effective alternative to opioids.”
The principle behind this treatment is the stimulation of the large non-nociceptive myelinated fibres of the peripheral nerves that inhibit the activity of small nociceptive projections in the dorsal horn of the spinal cord. In addition, and perhaps more significantly, SCS promotes the activation of GABA-B and adenosine A-1 receptors that lead to pain modulation.
“What has previously hindered traditional spinal cord stimulators was the implantable pulse generator, which had to be inserted deep into the skin. With the Stimwave, a wireless system that connects to an external pulse generator, there is no need for an implanted battery,” he explains further.
Traditionally, patients that have benefitted the most from this type of stimulation are those with chronic leg (sciatica) or arm pain, which may be caused by arthritis, spinal stenosis or nerve damage. Other patient profiles include those with failed back surgery syndrome, where surgery was undertaken to relieve back or leg pain as well as those patients with back or neck pain that has not responded to other therapies. Patients with arachnoiditis (inflammation or scarring of the spinal nerve lining) have also benefitted from the stimulation.
“The research I have seen provided solid evidence that the wireless SCS is an effective and safe treatment option – which is why I have chosen to offer it to my patients,” says Dr Oberholzer, “Stimwave has announced publication of the results of the first ever randomized, controlled trial (RCT) comparing wireless high-frequency (HF:10 kHz) spinal cord stimulation with wireless lower-frequencies of multiple mixed waveforms (LF: 20 – 1500 Hz tonic, burst, high density) for the treatment of failed back surgery syndrome in Pain Medicine. The direct to permanent study showed true paradigm shifting outcomes for the battery-free, opiod free pain management system, with subjects receiving an average of 77% back pain relief with 84% being in remission long term. This really does give patients the maximum ability to modify their programming to fit their individual pain management needs.”
To practice interventional pain management, a physician is usually accredited as a Fellow of International Pain Practice (FIPP), which requires practical training and an examination offered by the World Institute of Pain. There are currently 12 physicians in South Africa with this qualification, including Dr Oberholzer.
“The benefits I see for my patients is primarily the reduction of a dependency on opioids. With such chronic and excruciating pain, their quality of life is definitely affected – even leaning towards suicidal tendencies in some cases. With the risk of serious dependencies on analgesics to reduce their pain and the complications that go along with this dependency, I feel I can give them their life back,” asserts Dr Oberholzer. Pain levels show between 60 – 80% improvement; this is hugely significant to the quality of life being experienced.
With a simple insertion of the SCS done under local anaesthetic and sedation when the electrodes are placed in the epidural space through a percutaneous needle technique, no open surgery is required. For patients with medical aids, a large portion of the costs may be covered by the prosthesis allowance and the balance is either for the client or can be claimed from gap cover if the specific policy applies.
In the life of someone suffering chronic pain, the longevity of the solution is important. The big advantage is that the system uses an external rechargeable power source with impulses sent through a wireless transcutaneous system.
The risks to the patient are also minimal as there is no need for major surgery. Complications that may occur include haematomas, infection, abscess, temporary neck stiffness or headaches. Dr Oberholzer does note that these are very rare.
Overall, he believes that selection of the right patients, matching electrodes to the right placement area and the physician understanding the mechanism of action are all important to the success of such treatment.
“I believe that this is really a positive, long-term solution for my patients. Reducing their reliance on medication to manage pain and managing the costs related to treatment of the chronic condition,” he concludes.
Clinical Team (From left to right)
Mr R Farrell (NeuroSpine SA)
Mr B Perryman (Stimwave USA)
Mrs E van den Berg (Enrolled nurse)
Dr M Schopman (Anaesthetist)
Dr AJ Oberholzer (Pain physician)
Mrs G van Eck (Enrolled nurse)
Si E Oosthuizen (Professional nurse)
Mrs CJ Gunston (Radio graphist)
Mrs C Erasmus (Radio graphist)