Advances in technology offer ‘real hope’ to people living with chronic pain

Renewed clarity of mind has been a welcome surprise for Kevin Collins since having pioneering surgery for the management of chronic pain in a Dublin hospital.

Other, more expected benefits, include a significant lift in pain and aches around his body and in the fatigue he was experiencing, 15 years on from being diagnosed with multiple sclerosis (MS) in 2008.

“I find myself now daydreaming, thinking about things a lot more – more engaged with what I’m doing,” says the 54-year-old. It is only since becoming the first patient in Europe to have a new, advanced version of a spinal cord stimulator implanted after it was licensed for commercial use in the EU, that he realises the “dampening effect” the chronic pain was having on his brain in trying to cope with it.

A spinal cord stimulator (SCS) delivers mild electrical impulses to the spine, with the aim of disrupting pain signals before they reach the brain. This new Inceptiv device, developed by Medtronic, uses closed loop technology to monitor body movements 50 times a second and constantly adjust stimulation to optimum levels.

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Collins, who lives in Glenageary, Co Dublin, with his wife Janet and their 13-year-old daughter Caoimhe, has a MS lesion in his neck. He is a keen sea swimmer and believes this new technology, currently only licensed in Japan and the EU, particularly suits him.

I was heading towards a dead end in terms of medication and I was using stuff that you don’t want to be on for long

“My head moves a lot in my swimming.” He swims about three times a week at the Forty Foot in Sandycove, all year round. If he hadn’t had the benefit of this newest type of SCS, he reckons he would probably have had ups and downs of pain and tingling rather than the constant relief this offers. “We’re talking about 50-60 per cent [pain reduction],” he explains. “There’s still discomfort and there’s still MS” – but it has made life significantly easier for him.

Before the surgery, the pain he was living with “was starting to bite into me as a person and family life, and my being present in situations”. His increased dependency on painkilling drugs was one of the main reasons he went for this option. “I was heading towards a dead end in terms of medication and I was using stuff that you don’t want to be on for long.”

The swimming, along with the medications and support of family and friends, are what kept him sane. He had to give up his very physical job in forestry, which involved visits to the Wicklow mountains three or four times a week.

“I just had to chuck it in, which was a real heartbreak because you are spending your time in a landscape that tourists come to visit. It was amazing.” But he was able to transfer to a desk job, still within the forestry section of the Department of Agriculture.

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He has been able to continue swimming. “You might limp down to the edge of the water but [within] the first couple of seconds the body just kicks into action.” He has swum 3k races “and I would have difficulty walking 3k”. It is a “natural high and my body was getting good exercise”, says Collins, who enjoys the camaraderie of the “very inclusive” Forty Foot community.

“The cold water was always kind of a refuge – where my body felt ‘normal’, like it did before. The head gets cleared out too – it was really important and still is.”

The Inceptiv device was implanted into Collins in two stages by Prof Paul Murphy, consultant in anaesthesia/pain medicine at St Vincent’s Private Hospital. In the first operation last October, the wires were placed in his spine. Collins was woken halfway through to answer questions as the medical team checked the wires’ positioning, before he was put back under general anaesthetic so they could complete the process.

He then wore an “old fashioned” stimulator taped outside the body, as a trial run “to see if my body was reacting to it and getting benefits from it”. In a second operation a fortnight later, the Inceptiv device was implanted under his skin and connected to the wires.

Collins noticed a difference as soon as pain around the site of the surgery faded away. “I wasn’t reaching so quickly for the [pain relief] medications in the afternoon; I didn’t feel I needed it.”

Going the way I was going, I don’t know where you would be in two or three years’ time. But with this, something new has started

Implantation of Inceptiv is covered by private health insurance, but is also available in St Vincent’s public hospital. Prof Murphy expects to implant about 50 devices this year. “I was given six programmes giving different intensity of signal at different points on the wire,” says Collins. “Some of these could benefit me during particular times of the day.”

His smartphone links to the device and he uses it to change programmes, or alter the intensity within programmes, or switch the whole thing off if, say, going through airport security. “You do have a certain level of control.”

Extra intensity can give you extra benefits “but sometimes you get a slight tingle which can be a bit uncomfortable, so it’s a bit of a trade-off”.

He has to charge it about every two days using a belt that sits over the unit and charges it up through the skin. It’s quick and can be completed while, for instance, watching an hour-long TV programme.

The next step will be systematically reducing his medications. “I am looking forward to getting off the meds as much as possible and hopefully I will be able to drive them right down.”

Prof Murphy says chronic pain is debilitating, affecting every part of a person’s life and is a significant cost to society. “Advances in SCS technology offers real hope to people living with chronic pain. It gives them greater control to self-manage their pain and will reduce the need for hospital visits.”

About one in three adults in Ireland experiences chronic pain, according to the University of Galway Prevalence, Impact and Cost of Chronic Pain (PRIME) study. The Irish Pain Society estimates that chronic pain costs the Irish economy around €4.7 billion per year.

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Although Collins admits he was a “little bit panicky” about the thought of somebody operating on his spine, he is delighted to have gone ahead and hopes it will enable him to keep on enjoying life. “I was the first in Europe to get this technology on a commercial basis after release and the first in the world to get it in relation to damage in the neck region of the spine. It was a real buzz to hear that.”

Beforehand, he felt he was “at the end of the road” with pain killers. “Going the way I was going, I don’t know where you would be in two or three years’ time. But with this, something new has started. I am thrilled.”

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