Raso: New pain treatments bypass need for opioids

Nearly 52 million Americans experienced chronic pain in 2021, according to a new report from the Centers for Disease Control and Prevention. It’s one of our nation’s most common health problems, with new cases outpacing diagnoses of other chronic conditions, including diabetes, depression, and high blood pressure. And it truly is “chronic.” Although chronic pain is defined as lasting three months or more, almost two-thirds of Americans who develop the condition are still suffering from it a year later. In 2021, more than 17 million Americans had high-impact chronic pain, which affected day-to-day functioning and often prevented them from engaging in basic activities of daily living. Chronic pain is so prevalent in part because the current standard of care is insufficient, with limited options beyond opioids and invasive surgeries. That standard needs to change. Medical science has developed technologies that can effectively treat chronic pain for certain patients when other methods have failed. Policymakers and insurers must ensure qualifying patients have access to them. Undertreatment has serious consequences. In the United States, chronic pain is the number-one cause of disability. People suffering from it often experience depression and anxiety. Then there’s the economic burden of chronic pain – estimated at a staggering $635 billion, more than heart disease and cancer combined. Providing access to innovative interventional therapies for chronic pain would alleviate not just the suffering of individuals but some of the strain on our healthcare system and economy, too. In recent years, researchers have developed innovative medical devices that provide targeted therapy for certain kinds of chronic pain. Spinal cord stimulators, for example, are implanted and work by interrupting the pain signals carried from the nerves to the brain. Some of my patients suffering from moderate lumbar spinal stenosis have received the Vertiflex™ Procedure (Superion™ Indirect Decompression System) from Boston Scientific, in which a small interspinous spacer alleviates pressure on compressed nerves to relieve leg and back pain. Scientists are also working on devices that utilize cold therapy, ultrasound, and even virtual reality to relieve chronic pain. These alternatives may not work on every patient. But those who do benefit from them experience some advantages over traditional treatments. The latest medical devices for chronic pain are minimally invasive. In some cases, patients can use wearables that are available over the counter. Implants can be inserted in an outpatient setting. Side effects are usually minor. We cannot always say the same for surgery or treatment with opioids or other prescription drugs. Indeed, prescription opioid overdose deaths have surged in the last 20 years. And between 2019 and 2020, prescription opioid-involved death rates increased 17%. Patients who qualify for newer chronic pain interventions may avoid these risks. In clinical studies, medical devices have demonstrated significant pain relief and functional improvement in patients — and reduced reliance on opioids. Comparison studies of Vertiflex and common back surgeries, for example, have found that qualifying patients treated with an interspinous spacer device had fewer complications and were less likely to require a subsequent surgery. While this share of patients is much smaller than the total number of people who experience chronic pain — only encompassing a subset of people with moderate lumbar spinal stenosis — their experience represents a promising step for the continued development of minimally invasive treatments. Another novel therapy, which uses electromagnetic pulses to trigger the body’s natural pain relief mechanism, led to pain reduction of up to 36% after a single treatment session. These device-driven treatments offer hope for certain groups of people with chronic pain. However, they are not always accessible to patients. Many private insurers do not cover them. Some insurance plans routinely deny coverage for interspinous spacer devices, questioning whether there is enough long-term evidence to support their effectiveness. Because interspinous spacer devices are relatively new, there’s no way for us to have a long-term body of evidence on them yet — but that doesn’t mean they’re ineffective. The Food and Drug Administration has approved the Vertiflex™ Procedure, and expert medical organizations like the Multisociety Pain Workgroup and North American Spine Society recommend interspinous spacer devices. Research also suggests that they lower long-term costs for patients. Some patients, desperate for pain relief, have resorted to paying out-of-pocket for medical devices like these. But most cannot afford to bankroll their own treatment. More than 75% of patients surveyed by the U.S. Pain Foundation said that cost had prevented them from accessing treatment options for their pain. Non-invasive, drug-free treatments could revolutionize the way millions of Americans deal with chronic pain. The benefits of these medical devices are clear and backed up by solid clinical evidence. We must make sure that patients have access to them. Dr. Louis J. Raso is a board-certified anesthesiologist and interventional pain management physician in Jupiter, FL.