By Dr Tacson Fernandez
Consultant in Chronic Pain Management
Lead Clinician for Neuromodulation
Lead Clinician for Acute Pain Management
People who through no fault of their own have their lives demolished by pain deserve our help. Professor Henry McQuay from Oxford clearly highlights the plight of chronic pain sufferers in his article in the BMJ 2008, “Help and hope at the bottom of the pile”1.
A detailed reference in the Chief Medical Officers report the same year also highlighted the importance and impact of chronic pain on the society. The report aimed to raise awareness to the fact that patients with chronic pain are underserved and there is a need for medical attention to the field of chronic pain.2
Chronic Pain is a serious problem globally with significant socio-demographic, economic and health related concerns. Estimates suggest that 20% of adults suffer from pain globally and 10% are newly diagnosed with chronic pain each year. By 2030, the WHO predicts that the four leading contributors of global burden of disease, chronic pain is an important co-morbidity associated these.3
The economic impact of pain is greater than most other health conditions due to effects on rates of absenteeism, reduced levels of productivity and increased risk of leaving the labour market.4 A US study showed lost productivity amounting to $61/£32.34 billion per year due to chronic pain4, while a UK report confirmed £3.8 billion cost of management of adolescent pain alone2.
Technological advances over the years have assisted in management of severe chronic pain states including Failed Back Surgery Syndrome (FBSS) and Complex Regional Pain Syndrome (CRPS) as outlined in NICE tag 0159 through the use of implanted devices such as spinal cord stimulators.
Spinal cord stimulators are devices implanted in the epidural space. They send electrical impulses to the spinal cord thereby altering transmission of pain messages sent to the brain and modify sensations in the area of pain, to be felt as a tingling sensation. SCS does not eliminate the source of pain but simply changes the perception of pain in the painful area by altering transmission of signals to the brain.
In patients who have persistent neuropathic back and leg pain despite adequate corrective surgical management and anatomical stability, spinal cord stimulators have been beneficial in improving quality of life (QoL). A recent cost effectiveness and cost utility study8 demonstrated clinically and statistically significant increase in both clinical outcomes and QoL, 24 months after SCS implantation. The most important changes were found within the first six months of SCS treatment, and then maintained or slightly improved during the following period8.
There is need for a conscious and concerted effort for management of this under-recognised and under-treated condition, i.e. chronic pain, that has significant consequences5 on the global health image, global economy and most importantly people’s lives. Early diagnosis and management options such as Spinal Cord Stimulators (SCS) improves quality of life in a cost effective manner in complex chronic pain these patients.6,7,8
Mean Days Lost
Grahame's Story - Spinal Cord Stimulation at the RNOH
For more information please contact the Royal National Orthopaedic Hospital Private Patient Unit: 020 8909 5712/13
- Management of Chronic Pain
Help and hope at the bottom of the pile
BMJ. 2008 Apr 26; 336(7650): 954–955.
- Chief Medical Officers report 2008
- Chronic pain epidemiology and its clinical relevance
O. van Hecke, N. Torrance, B. H. Smith
Br J Anaesth (2013) 111 (1): 13-18
- The Cost and Burden of Chronic Pain
Ceri J. Phillips
Rev Pain. 2009 Jun; 3(1): 2–5.
- Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment
Harald Breivik, Beverly Collett, Vittorio Ventafridda, Rob Cohen, Derek Gallacher
European Journal of Pain 10 (2006) 287–333
- Treatment of chronic pain with spinal cord stimulation versus alternative therapies: cost-effectiveness analysis.
Kumar K, Malik S, Demeria D.
Neurosurgery. 2002 Jul;51(1):106-15
- Spinal cord stimulation versus reoperation for failed back surgery syndrome: a cost effectiveness and cost utility analysis based on a randomized, controlled trial.
North RB1, Kidd D, Shipley J, Taylor RS.
Neurosurgery. 2007 Aug;61(2):361-8;
- Cost‐Effectiveness and Cost‐Utility Analysis of Spinal Cord Stimulation in Patients with Failed Back Surgery Syndrome: Results from the PRECISE Study
Furio Zucco, MD, 1 Roberta Ciampichini, MSc, 2 Angelo Lavano, MD, 3 Amedeo Costantini, MD, 4 Marisa De Rose, MD, 3 Paolo Poli, MD, 5 Gianpaolo Fortini, MD, 6 Laura Demartini, MD, 7 Enrico De Simone, MD, 8 Valentino Menardo, MD, 9 Piero Cisotto, MD, 10 Mario Meglio, MD, 11 Luciana Scalone PhD, 2 and Lorenzo G. Mantovani, DSc 2
Neuromodulation. 2015 Jun; 18(4): 266–276.