A pioneering new technology is helping people to deal with chronic pain, writes David Labanyi.
Almost two years ago John Barry's right hand was crushed flat by a machine at work. Although he did not lose the limb, the injury was severe.
Nerves, muscles and tissue in the hand were damaged, resulting in compartment syndrome - which happens when nerves and blood vessels are crushed, impairing the blood flow and causing muscle and nerve damage.
Two years later, Barry has very limited use of his right hand. He can grasp a pen to scrawl a signature, but cannot write for any length, and heavy activity such as mowing the lawn causes the hand to swell.
However, by far the most significant element of the injury was the constant, chronic pain.
Six months after the injury, the acute pain was causing Barry to become depressed.
"I was on a range of painkilling medication, three or four tablets a day. They'd give relief for a while and then become less and less effective and we'd have to change medication.
"With constant pain like that you suffer a lot of depression. I was very active before the injury. That comes to a stop and you get very frustrated.
"The pain would keep me awake at night. You'd be contrary with the family and friends. What I found too was that after a while they get fed up listening to you."
Barry's experience is not unique. Up to 13 per cent of the population will experience chronic pain either as a result of a serious injury, or conditions such as arthritis.
To date, medication has been one of the most frequent treatments. However, Barry is one of a select group of people now using a pioneering new technology - spinal cord stimulation.
During the summer, Barry had an operation to place a wire with a series of electrodes close to the top of his spine.
One week later, during a second operation, a small disc-shaped sealed battery was inserted in his side and connected to the electrodes.
By using a pattern of electrical pulses between the electrodes to interrupt the pain signals coming from the damaged hand, the chronic pain Barry was experiencing has been replaced with a mild tingling sensation, which, since he became accustomed to it, is far superior to the relief offered by medication.
"The difference between this and the drugs is unreal. I can manage day to day now. And without the pain you wouldn't be nearly as contrary, the depression has lifted," says Barry.
"To be able to walk back to the pharmacy with a bag of medication and hand them back was brilliant. I don't take any medication for pain now, just one tablet for inflammation," he says.
Once the electrodes are implanted, they are programmed to meet the needs of the patient with pulses of different strengths and frequencies tested with the patient.
Once the battery is implanted the patient is given a remote control type device allowing them to switch between a number of settings, to respond to changes in the severity of the pain.
This control device will also warn the user when the battery is running low using a display similar to that on a mobile phone.
"I have to charge myself every two or three weeks with a charger unit. I strap it to my chest, it is actually like a metal detector.
"It starts beeping when you get close to the battery, and the minute the charger unit is directly over it, the beeping stops. It charges through the skin."
Barry carries a card explaining that he has the implant in case it sets off a shop security alarm or airport security system.
"I set off the shop alarm in Harry Corry's one day.
"I showed them the card, the same as people with a pacemaker, so there is no problem."
Barry is hoping now to return to work and is talking to an occupational therapist to see what he can and cannot do.
The surgeon who carried out the procedure was director of pain medicine in Tallaght Hospital, Dr Camillus Power.
Tallaght and St Vincent's Hospital, Dublin run the only two cognitive behavioural therapy programmes for people in chronic pain.
Between the two centres - the St Vincent's one is run by Dr Declan O'Keeffe - more than 100 people have had similar implants to counteract chronic pain.
Power says around a quarter of all chronic pain sufferers have neuro-pathic pain, a dysfunction of the nervous system.
He says while the cost of each implant is expensive at €27,000, this is recouped within a couple of years as a reduction in medication costs and the fact that many recipients can return to work.
"Reducing the amount of medication necessary and giving patients an improved outcome, that is the aim."
Tallaght runs the Ulysses programme for patients in chronic pain. This involves a combination of treatments, including physiotherapy, psychology, occupational therapy, relaxation techniques and, crucially, exercise.
"While it is perfectly understandable that someone in pain doesn't want to move, if you become inactive it generates more medical problems in the long term. And you become depressed."
Power says research suggests that after a period the nervous system starts to process pain differently, meaning the symptoms can persist long past the initial injury or operation.
Surgeons in Ireland are starting to use the implant technology in new ways.
"We have one lady who has a lot of disease near her spine, and it was impossible to put the electrodes into the epidural, so we implanted the leads alongside her spine under the muscles.
"This is a new use of the technology and she is now getting good relief," he says.
To deal with demand from patients with chronic pain Power would be keen to see an additional consultant anaesthesist specialising in pain management appointed to Tallaght.
He would also like chronic pain to be classified as a disease.
"If you are trying to explain to someone that you have diabetes or asthma, that is easily understood and people can empathise.
"Chronic pain is less well understood."
This difference in perception translates to the medico-legal arena. "I am always struck by why we put patients with chronic pain through such trauma.
"With no other chronic conditions would you find yourself being cross-examined about why you did or didn't take a form of exercise or a particular medicine," he says.
"I believe this could be reformed. Not least because at the moment we have the crazy situation that clinicians who are very busy, are spending a lot of time in court answering questions."
Power says the number of people exaggerating the extent of their pain is "very, very small and grossly overestimated".