Five New Technologies for Pain Management

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Virtual reality worlds immerse patients into a full-body sensory experience. Copyright Hunter Hoffman, University of Washington, all rights reserved.
Virtual reality worlds immerse patients into a full-body sensory experience. Copyright Hunter Hoffman, University of Washington, all rights reserved.

With the rise of the opioid epidemic, clinicians and researchers are searching for alternative methods of pain relief. Below, we explore 5 technologies recently developed to manage pain.

1. HEAT Pain Pro™ TENS Device

Company: Omron Healthcare

Release Date: Its arrival was announced on October 4.

Applications: Acute joint and muscle pain

About this technology: This over-the-counter device combines heat with transcutaneous electrical nerve stimulation (TENS) to provide pain relief for acute joint and muscle pain.

TENS relieves pain by sending electrical pulses across the skin and along nerves, thus preventing pain signals from reaching the brain. In addition, electrical stimulation can also lead to the release endorphins, which provide natural pain relief.

While the technique of combining heat with TENS is already used by physical therapists, this is currently the only device of its kind available on the market. Previously, patients would have to receive TENS from a doctor or health practitioner.

“Increased awareness of the potential dangers of opioids and prescription pain killers is driving more consumer interest in pain management options,” Carol Lucarelli, director of marketing and product development for Omron Healthcare, Inc, said in a statement. “The Omron HEAT Pain Pro™ is a safe, effective, accessible drug-free choice.”

Efficacy: Despite the widespread use of TENS, its effectiveness is still being evaluated, and according to the United Kingdom's National Health Service (NHS), much of what we know about TENS' effectiveness is based on personal experience rather than scientific evidence.1 Many clinical trials are still ongoing.

The HEAT Pain Pro™ TENS Device has 27 combinations of heat and TENS, 20 levels of intensity, and has pre-set options for different locations of pain, including the lower back, arms, legs, feet, shoulders, and joints.

It has a rechargeable battery, gel pads that can be used 30 times before replacement, and fits in the palm of the hand. It is available through OmronHealthcare.com, Amazon, CVS, and Walgreens without a prescription. The suggested retail price is $89.99.

To find out more about the TENS device, watch this video:


2. Radiofrequency Ablation Devices

Companies: St. Jude Medical, Inc, Haylard Health, Inc, Boston Scientific Corporation, Diros Technology, Inc

Release Date: This treatment has been available for some time, but is expected to gain traction due to rising numbers of people with chronic pain conditions.

Applications: Chronic pain conditions, geriatric pain

About this technology: Radiofrequency (RF) therapy uses the heat generated from a medium frequency alternating current (350-500 kHz) to denervate tissues that are part of the peripheral nervous system. When performed with a catheter, it is called radiofrequency catheter ablation. Radiofrequency ablation is a minimally invasive alternative to surgery.

Due to an increase in chronic pain conditions, as well as the rising global geriatric population, the demand for radiofrequency ablation for pain is expected to increase, according to a report from Transparency Market Research.

Benefits of this technology include reductions in surgery-related complications, adverse effects, recovery time. In addition, the device is easily available and cost-effective.

In a 2014 study published in Anesthesia & Analgesia, researchers found that out of 77 patients receiving RF therapy for refractory sacroiliac joint (SIJ) pain, more than half received some pain relief for at least 6 months after RF therapy.2

3. ActiPatch®

Company:  BioElectronics Corporation

Release Date: Will be featured at Pharmacy Week in Trinidad and Tobago, October 16th to the 23rd, 2016.

Applications: Chronic pain from osteoarthritis, rheumatoid arthritis, shingles, neuropathy, sports injuries, and fibromyalgia, and post-surgical pain

About this technology: Actipatch is a non-invasive, electroceutical device which uses electromagnetic fields to modulate efferent nerve activity, dampening the brain's perception of pain. The device pulses signals at 1 kHz into the painful tissue, preventing the brain from adapting to the stimulus.

Efficacy: Completed clinical trials indicate device efficacy in reducing pain (including musculoskeletal, postoperative, and menstrual pain), and restoring normal function, such as allowing people to get a full nights' sleep, in many patients.

A trial published in Pain Management showed that out of 5002 study participants who provided feedback after testing the ActiPatch, efficacy rate varied from 59% to 71% for different pain conditions, with an average of a 50% reduction in medication use (including prescriptions).3 Sixty seven percent of study participants reported that they were able to eliminate or reduce opioid use, 70% reported improved sleep, and 74% reported that they could be more physically active.

According to Ken McLeod, PhD, Director of Clinical Science and Engineering at Binghamton University, patients using ActiPatch do not feel any tingling, heat, or vibration, unlike with TENS.

It is currently the only neuromodulation electroceutical device available over-the-counter for managing chronic pain. It is safe to use with metal implants, pacemakers, and defibrillators, as well as in diabetics, arthritics, and the elderly. It is not for use in pregnant women. It allows for 720 hours of use and has an on/off switch.

Device distributors are listed here.

Learn more about this technology:

4. BurstDR Stimulation

Company: St. Jude Medical, Inc

Release Date: The United States Food and Drug Administration (US FDA) device approval was announced on October 4, 2016. 

Applications: Chronic pain

About this technology: This new physician-designed form of spinal cord stimulation (SCS) provides “bursts” of pulses that mimic natural nerve impulse patterns in the body, unlike other types of SCS.

This burst mode was developed to prevent the body from becoming accustomed to SCS therapy and developing a tolerance, a common occurrence in SCS.

Efficacy: At the North American Neuromodulation Society meeting in Las Vegas, Nevada, researchers presented results from the SUNBURST study, in which 100 patients enrolled from 20 centers in the US were randomized to receive either tonic stimulation prior to burst stimulation, or burst stimulation prior to tonic stimulation, with a device that could perform both.

The results revealed that 69.4% of patients preferred the burst stimulation for treating chronic pain, and 91% also reported a decrease in paresthesia, compared with traditional SCS.

Allen Burton, medical director of neuromodulation and vice president of medical affairs at Saint Jude, also noted that the 21% who preferred traditional SCS could also be accommodated; the SCS devices are capable of both and will have “built-in patient choice.”

The burst therapy has been available in Europe since 2014 and is incorporated into the rechargeable Prodigy and Protégé rechargeable SCS devices, as well as the Proclaim non-rechargeable system.

Now that the US FDA has approved the therapy, patients who receive new implants of the St. Jude Medical Proclaim™ Elite and Prodigy MRI™ spinal cord stimulation systems will be able to access the burst therapy immediately. Those who already have the upgradable Protégé and Proclaim SCS systems will be able to upgrade and access the burst therapy without surgery.

“I am very excited that patients across the United States will now have access to BurstDR stimulation, which has enjoyed strong success across other global markets,” said Professor Dirk De Ridder, MD, PhD, from the University of Otago in Dunedin, New Zealand.

“When I developed BurstDR stimulation, my goal was to introduce an entirely new therapy option, and one that was rooted in the natural way in which the human body responds to and combats the sensation of pain,” he said.

5. Virtual Reality

Company: DeepStream VR

Release Date: A 2007 study examined how the VR game “SnowWorld” affected pain relief. Developments to virtual reality (VR) games continue, with the current VR game “Cool!” copyrighted in 2014.4

Applications: Chronic pain

About this technology: VR worlds immerse patients into a full-body sensory experience. They differ from movies or games visualized on a screen due to their level of interaction and immersion that command a higher level of brain attention.

In Cool!, patients wear a VR headset and explore a 360 degree immersive world, using a mouse to toss fish and magic orbs to playful otters, all this, in a beautiful landscape.

Efficacy: Ted Jones, PhD, from the Behavioral Medicine Institute in Knoxville, Tennessee,  and colleagues conducted an independent study to determine whether DeepStream VR's pain relief game “Cool!” would provide pain relief to patients with neuropathic pain.5

The first study examined a single, 5-minute treatment session in 30 patients with neuropathic pain. The researchers found that pain decreased an average of 60% during the session and 33% after the session, and the relief lasted from 2 to 48 hours after completion of the game.

“This study supports wider use and further study of VR pain control therapy as an adjunct or potential replacement to traditional pain therapy. These findings are especially significant and timely in light of the strong clinical shift away from opioid drug therapies,” the researchers wrote.

The second study is examining multiple 20-minute treatment sessions in 7 patients, and is still ongoing.

Watch a demonstration of DeepStream VR:

 

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References

  1. Vance CG, Dailey DL, Rakel BA, Sluka KA. Using TENS for pain control: the state of the evidence. Pain Manag. 2014;4(3):197-209.
  2. Schmidt PC, Pino CA, Vorenkamp KE. Sacroiliac joint radiofrequency ablation with a multilesion probe: a case series of 60 patients. Anesth Analg. 2014;119(2):460-462.
  3. Rawe IM, Kotak DC. A UK registry study of the effectiveness of a new over-the-counter chronic pain therapy. Pain Manag. 2015;5(6):413-423.
  4. Hoffman HG, Richards TL, Van Oostrom T, Coda B, Jensen MP, Blough DK, Sharar SR. (2007). The analgesic effects of opioids and immersive virtual reality distraction: evidence from subjective and functional brain imaging assessments. Anesthesia and Analgesia, 105(6), 1776–83, table of contents. doi:10.1213/01.ane.0000270205.45146.db
  5. Jones T, Moore T, Choo J. The Impact of Virtual Reality on Chronic Pain. Available at: http://www.deepstreamvr.com/wp-content/uploads/2016/05/VR.APS2016_final.pdf. Accessed October 18, 2016.
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