Spurred by the opioid crisis, a once marginalized therapy that relies on electrical stimulation to treat chronic pain is undergoing a renaissance as device makers race to upgrade their products for a wider population of patients.
The companies believe the therapy, known as neuromodulation, can reduce reliance on opioid painkillers, which laid the foundation for a spike in overdose deaths and led to a fierce debate over how best to treat patients with chronic pain. It is also seen as a significant business opportunity, with one research firm predicting that the market for neuromodulation will grow by 15 percent a year, to more than $16 billion by 2024.
Over the past four years, device makers have introduced products that deliver stimulation at different frequencies and levels of intensity, expanding the number and type of patients that may be candidates for neuromodulation. The therapy involves the surgical implantation of a spinal cord stimulator that, when turned on, delivers mild electric pulses to nerve fibers in the spinal cord. The electricity interrupts the pain signals that are carried to the brain, providing relief to patients.
In addition to improvements in stimulation techniques, device markers are adding wireless bluetooth technology to spinal cord stimulators to allow doctors and patients to adjust the intensity levels in real time; tablets and smartphones are also making it easier to collect and report data on patient progress and outcomes.
“That’s where the field is turning — there’s been a movement to make sure we have validated outcomes that accurately represent what patients are telling us,” said Dr. Mark Bicket, director of the pain fellowship program at Johns Hopkins University. “We have some active studies going on at Hopkins and other places looking at patient function with devices like Apple Watch and other wrist-based measurements.”
Medtronic sponsors a grant for pain fellows at Johns Hopkins, but Bicket does not receive direct payments from that program.
It would be impractical and incredibly expensive for every chronic pain patient now taking opioids to get these implants. But pain specialists say neuromodulation is part of the solution to alleviating pain and should be considered earlier in the treatment process, instead of as a last resort. Research is underway to determine which types of patients benefit most from the newer devices on the market.
Neuromodulation was the focus of a session at this year’s Consumer Electronics Show in Las Vegas, where device makers gathered for a discussion titled, “The Solution to the Opioid Crisis No One is Talking About.” The largest players in the market participated, including Boston Scientific, Medtronic, Abbott, and Nevro, which began marketing its products in the U.S. in 2015.
“What we are offering and talking about up here is a therapy that can be considered for patients who have chronic pain before they ever get on opioids,” said Dr. David Caraway, Nevro’s chief medical officer. “Or, if they are on opioids, we can get them off opioids or reduce their dose down to safer levels.”