Spreading the News

The market for spinal cord stimulation systems treating chronic back and leg pain has advanced dramatically over the last 20 years. In the beginning the market was dominated by one player, Medtronic, offering one basic form of therapy, tonic dorsal column stimulation. Since that time, not only have new competitors entered the market, but a steady stream of new paradigms has emerged, including DRG stimulation, high-frequency paresthesia-free stimulation, closed-loop stimulation, glial cell activation, and low-frequency stimulation. The parade of new players and plethora of therapeutic variations have made some people wonder whether the market can support all this competition. The answer to that question, we believe, will depend on how well the industry spreads the word to new pain patients and their clinicians.

Two recent publications draw attention to the challenge confronting the SCS market. Writing in the Journal of Pain Research, a team of clinicians from the University of Arkansas for Medical Sciences pointed out the lack of neuromodulation knowledge among rural family medicine doctors. The shortfall was particularly glaring with patients suffering from post-laminectomy syndrome—also called failed back surgery syndrome or persistent spinal pain syndrome—perhaps the bread and butter for SCS. A survey of rural doctors conducted by the authors found that while 41 percent of them had treated patients with FBSS/PSPS, only 10 percent had used or referred neuromodulation therapy. Worse, they found that despite evidence of a lack of efficacy and increased morbidity with the use of opioids for treating chronic pain, they’re still routinely used. Arkansas physicians prescribed opioids in 93.5 out of 100 cases in 2018, compared to the national average of 51.4.

The authors argue that basic principles of implementation science would help address this problem. “While increased dissemination of this data through targeted education, lectures, and conferences may be helpful, we feel that the proven methods of implementation science research could be a large asset to the neuromodulation community,” they write.

Another article in the journal Neuromodulation reported that less than 1 percent of people in England with neuropathic pain have received an SCS device. “The recommendation for routine use of SCS for management of neuropathic pain has not resulted in an uptake of SCS over the last decade,” the authors report.

Clearly, SCS vendors have their work cut out for them. If the industry is going to support all the new players and new therapeutic options entering the market, it will have to do a better job of spreading the good news about SCS to more chronic pain patients and clinicians.

James Cavuoto
Editor and Publisher


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