August 2022 issue
August 31, 2022 | A mostly in-person audience of pain doctors, neuromodulation industry professionals, and researchers attended the 2022 Napa Pain Conference earlier this month in the wine country of California. The event was produced by Neurovations Education, a company founded by Eric Grigsby.
A preconfernce workshop was devoted to cancer pain. Katalin Karikó from the Perelman School of Medicine at the University of Pennsylvania, who invented the modified mRNA technology used in vaccines to prevent COVID-19 infection, delivered the 10th Annual Lindahl Lecture on the first day of the event.
Penney Cowan, founder and CEO, of the American Chronic Pain Association, delivered the 8th Annual Legacy Lecture on the topic: Help, Hope, Learning. Cowan described her organization’s tools that pain patients can use to communicate their condition to clinicians. These include a quality of life function scale, which she said was much more useful than a 1- to 10 visual analog scale. “We’re going to measure function instead of pain,” she said. “Because really, isn’t that what it’s all about?” Other tools include a daily activity checklist and an interactive pain log that tracks triggers and progress.
Although the conference was devoted to a number of different therapies for treating pain, neuromodulation fared well in the mix. In a talk on the subject of advances in neuromodulation, Parag Patil, an associate professor of biomedical engineering at the University of Michigan, gave attendees a background on various forms of pain neuromodulation. He noted that the different approaches such as DRG, closed loop, or burst stimulation likely have different mechanisms of action. For example, burst and high-frequency stimulation may have a differential effect on myelinated versus unmyelinated axons. In addition to neuropathic and nociceptive pain, Patil described a third type called nociplastic pain, which arises from altered nociception.
Maxim Eckmann, professor of anesthesiology and pain medicine at the University of Texas Health Science Center, discussed the pros and cons of PNS and SCS devices for treating chronic extremity pain.
David Copenhaver from UC Davis Health discussed new therapies in treating diabetic peripheral neuropathy. He also discussed diagnostic tools for detecting DPN, including EMG, nerve-conduction studies, vibration testing, and superficial pain sensation testing.
In a pair of sessions devoted to unmet needs in neuromodulation, Nagy Mekhail from the Cleveland Clinic, presented data comparing SCS neuromodulation to targeted drug delivery. He said that female patients tend to get better results than males with SCS but that the percentage of successful pain relief with SCS declines dramatically with age. The opposite is true with targeted drug delivery—males do better than females and percentage of successful pain relief increases with age.
Mekhail noted that compared to both DBS and VNS devices, SCS therapies have a much lower 10-year survival rate: 56 percent compared to 91 percent and 97 percent for DBS and VNS respectively. The main reason for explant among patients failing long-term SCS therapy is loss of efficacy, he said.
Alexander Feoktistov from the Synergy Integrative Headache Center, gave a detailed talk on the subject of noninvasive neuromodulation for primary headache disorders. He presented positive data from electroCore, Theranica, Cefaly, and Neurolief.
David Dinsmoor from Medtronic presented research conducted by his firm and collaborator Lawrence Poree of UC San Francisco comparing conventional and burst stimulation. Using s sheep model, the investigators He noted that previous studies showed that burst stimulation offered marginal improvements over conventional stimulation but at the expense of using more energy. The researchers used evoked compound action potentials from both the anterolateral system and the dorsal column to gauge neural activation. They concluded that there was no significant difference in activation between burst and conventional SCS when the two approaches were dosed in an equivalent manner.
Linda Porter, director of pain policy at the NIH National Institute of Neurological Disorders and Stroke, gave a talk on the future of pain research funding. “The world of pain research is changing drastically through the HEAL initiative additional funds,” she said.
Exhibitors at the conference included Abbott, Boston Scientific, Nevro, Bioventus, Neuronoff, Applied VR, and Avanos.
