Chronic back pain is a serious problem for millions of Americans, affecting the quality of their everyday life. For many, the pain results from a syndrome known as “failed back”.
Failed back syndrome is said to occur when a patient damages their back and has a period of rest or a medical or surgical treatment which – though it resolves a mechanical problem such as a slipped disc – leaves the sufferer in chronic pain.
What often happens in these cases is that nerves lying close to the spinal cord have been damaged and continue to transmit pain messages to the patient.
Traditionally, doctors have treated the pain associated with failed back by medicating the patient. Painkillers can certainly help when back pain is acute but they’re not a good treatment for chronic pain. Tolerance can easily build up, making analgesics ineffective unless they’re taken in large doses and the more powerful painkillers, such as codeine and morphine, can lead to addiction. Certain painkilling drugs also carry the risk of adversely affecting patients’ ability to breathe and to concentrate effectively.
Now, a new solution to failed back pain has been developed in Britain. Dr Adnan Al-Kaisy is a Consultant in Pain Medicine at Guy’s and St Thomas’ Hospital in London and has operated on failed back patients with great success. His technique involves a variation on the old tried and tested method of spinal cord stimulation.
Dr Al-Kaisy says that the new version of spinal cord stimulation can help back pain sufferers even when their problem seems insoluble. A small battery-powered device is put into the lower back or abdomen to send mild electric shocks to the spinal nerves. The shocks, paradoxically, generate pleasant sensations which cancel out the pain.
The innovation – the RestoreSensor – enables more precise placing of the electrodes which deliver the tiny electric shocks. Past surgery to place them in the patient’s body ran into a difficult problem. Because the electrodes were free-floating – near the spinal cord but not fixed there – they could move. When a patient moved, the electrodes could move too and sometimes this meant they were brought into close contact with nerves, resulting in uncomfortable or painful shocks. This meant patients would need to turn off the device at unpredictable times.
The RestoreSensor, approved in the UK in May 2010, means that spinal cord stimulation now uses the Earth’s gravity to respond naturally to a patient’s position and adjust the electric shock signals automatically. This simple medical advance means that the painkilling technique is more reliable and needs less management by the patient.
Operations to insert the device take around an hour and a half and require only light sedation in the first stage and then general anaesthetic as the RestoreSensor is implanted. The patient is able to tell the surgeon in which location the device gives most pain relief. Dr Al-Kaisy explains that he uses X-rays to guide his work and place two wires, carrying 16 electrodes, alongside the spinal cord. Once the patient confirms the spot that gives the greatest relief, a general anaesthetic is given and the leads and neurostimulator are implanted. Only a couple of small incisions are required.
Once the sensor is switched on, patients’ pain relief works automatically. The neurostimulator has a battery which can be charged in situ so the newly-painfree patient needs no further treatment or surgical intervention.
The first patient to have the RestoreSensor fitted in the UK was agricultural engineer James Mason, aged 36. He suffered eight years of back pain after an accident at work.
Commenting on the RestoreSensor, he says: “I’ve been moved to tears by the effectiveness of this treatment. I sleep for hours uninterrupted, can walk my children to school and sit them on my knee. I’ll be looking for a job again too. I feel like I’ve got my life back.”