Sharing the Pain
It did not come as a major surprise when we learned that the American Academy of Orthopaedic Surgeons issued a statement earlier this month on “opioid use, misuse, and abuse in orthopaedic practice.” Orthopaedic surgeons are the third highest prescribers of opioids in our healthcare system. AAOS joins the American Academy of Neurology and other medical groups in calling attention to the serious epidemic that was created by the pharmaceutical industry—with the cooperation of clinicians, insurers, and regulators—to capitalize on the market opportunity that chronic pain represents [NBR Sep14 p2].
The opioid addiction epidemic has not only caused massive problems and financial burdens in its own right—opioid addiction is now the leading killer of young adults in the U.S.—it has also helped reignite a heroin addiction epidemic in all corners of the country. The New York Times recently cited an assessment of that link by addiction specialists at the Cleveland Clinic. They point out that heroin is much cheaper than prescription opiates in many parts of the country, giving addicts a seemingly cost-effective alternative.
This situation creates an opportunity for the neuromodulation industry to present their case for pain devices. Indeed, AAN and AAOS might well be potential partners in an education and outreach program to highlight alternatives to opioids for treating chronic pain. The silos created by clinical specialties to maintain control over their patients has in the past been a barrier to adoption of neurostimulation devices.
There is a much wider range of pain stimulation devices available today than there was 10 years ago. Neuromodulation vendors have made enormous progress developing new stimulation paradigms to target specific types and regions of pain. Today, patients and their doctors can opt for therapies ranging from minimally invasive rechargeable or primary cell spinal cord stimulators to injectable or percutaneous devices to body-worn surface stimulators available over the counter.
But in exploiting this potential market opportunity, neuromodulation vendors must not make the same mistake that purveyors of opioid pharmaceuticals made 20 years ago, pursuing profit ahead of the needs of the patient. Recommendations must be based on solid scientific evidence and therapies should be custom-tailored to the specific needs of the individual patient.
Perhaps the strongest argument in favor of neuromodulation devices for treatment of chronic pain is the progress that investigators have made in identifying the neuronal mechanisms behind chronic pain and interventional therapies. We know much more today about the source of pain than we would have without the prior generations of neuromodulation devices and patients who used them.
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