There is new hope on the horizon for people with back pain, a leading cause of disability worldwide.
Four million Australians live with back pain – the banana farmer and auto mechanic in Coffs Harbor, Jaswir Grewal, is one of them.
Jaswir has a decades-long history of debilitating back pain caused by strenuous work, particularly the heavy lifting and bending that requires an auto mechanic. In the past, pain determined his life and “took over”. He had three spinal stiffening operations for a herniated disc, but they did not relieve his pain. Over time, Jaswir relied on increasing doses of oral opioids and fentanyl patches to get through the day, and he felt like he was “falling into a dark hole.”
Jaswir eventually traveled to Sydney to visit the Michael J. Cousins Pain Management and Research Center at the Royal North Shore Hospital. Jaswir is pleased that the pioneering Australian pioneer in pain medicine, Professor Michael Cousins AO, was his doctor. He knew that Professor Cousins had pioneered new pain treatments for back pain and hoped there would be light for him at the end of the tunnel.
One pain management technique that Professor Cousins watched as it developed was spinal cord stimulation, which first appeared in the 1970s. Pain specialists weren’t sure why spinal cord stimulators reduced back pain in some patients and not in others, but they believed the current produced by the device reduced the constant state of increased reactivity or windup in the central nervous system of people with chronic pain.
Professor Cousins said a big problem for researchers and pain specialists, even thirty years after spinal cord stimulators were introduced, was that they didn’t know how much stimulation was relieving pain.
“In the beginning, the stimulation of the spinal cord was robust. It was a one-way system. You put electrical pulses in but you didn’t know what happened to them unless the patient said, ‘Wow, it’s great or it’s awful,’ ”he said.
Another problem was that the stimulation often became too strong and could cause severe pain.
“When this happens,” explained Professor Cousins, “most patients reduce the volume of stimulation to avoid painful surges, thereby reducing the pain relief they receive.”
He remembers a patient with a traditional spinal cord stimulator who would always hold on to a wall or nearby bookshelf for support when coughing. Professor Cousins said he did this because he was receiving massive overstimulation – whipping the spinal cord – from a shock wave traveling through the spinal cord.
“His experience was like a small electric shock. Some people were blown away because it hurt so much. The patient eventually turned down the stimulation, which reduced his pain relief but prevented the unwanted overstimulation. “
Other patients reported a throbbing sensation with their stimulator. “The spinal cord contracts and swells with every heartbeat, and this can increase stimulation to painful levels,” said Professor Cousins. “For some patients, the older-style stimulators effectively turned off with every heartbeat. That meant it was on, off, on, off, on, off all the time. The tingling and tapping were the movements that the spinal cord superimposed on the sensory input. “
Yet thousands of people around the world have benefited from traditional spinal cord stimulation. In a 2011 interview with the Australian doctor, Professor Cousins said that spinal stimulators cause life-changing improvements in some patients. “It can save them from breaking the spiral of deterioration in mental and physical function that is so often seen in chronic pain.”
However, the devices have major limitations and pain specialists do not know why they help some patients and not others.
The limitations of traditional spinal cord stimulators worried Professor Cousins. In 2009 he worked with the scientist Dr. What followed was several years of grueling early morning studies on sheep in the intestines of a hospital building at the Royal North Shore Hospital in Sydney. After the new stimulator, which has a built-in feedback loop, was ready for testing in patients, Professor Cousins and Dr. Parker for a week in some patients. It worked and provided vital information to further refine the device.
In 2015, Professor Cousins told him about the closed-loop stimulator during an appointment with Jaswir Grewal at the pain clinic. He explained the risks of surgery and that the new device might not work.
“Do you want to try it?” he asked. “You would be the first person in the world to have it.”
Jaswe nodded. He took the risk because if it helped, his life would irrevocably change for the better.
On October 13, 2015, pain specialist Dr. Charles Brooker the device from Jaswir. Professor Cousins supported the process. Before the operation, Jaswir said his pain was eight out of ten, but after the operation it was two out of ten.
“As soon as they turned it on, the pain in my back went away,” said Jaswir. “It immediately gave me mental relief.”
After Jaswir’s operation, Professor Cousins supported him while he slowly turned down his opioid use. Now he’s excited to be completely drug-free.
“The stimulator has taken over my pain control,” said Jaswir. “It does all of the work of the opiates and other pain relievers I’ve been taking. My spinal cord stimulator is the best thing that has ever happened to me. “
Dr. Charles Brooker said that unlike previous spinal cord stimulators, closed-loop technology sends signals back from the body to aid treatment.
“The machine can adjust itself to accommodate any setting the patient wants,” he said. “This is a big step forward, because in the past, when people were moving or their heart was pulsing, various things made the electrical signal fluctuate quite sharply up and down. They would experience shock and in many cases would not be able to live their lives effectively. “
“It was a real eureka moment in pain medicine!” Said Professor Cousins. “Conventional implants are blind to what is happening. They pump out a signal. You can talk but you can’t listen. In comparison, the closed-loop device enables two-way conversation. It is the first device where the stimulus adapts in response to feedback from the patient’s nervous system, optimizing pain relief. By listening, the device regulates the amount of stimulus to match the level of pain and provides a dose of pain relief tailored to the needs of the patient at that point in time. “
Repeated studies around the world have shown that the closed-circuit stimulators provide significant pain relief in the majority of patients 18 months after implantation. These studies have shown that overstimulation, jarring, and knocking do not occur with a closed system, allowing patients to maintain a constant current of stimulation and pain relief even when coughing.
* Gabriella Kelly-Davies is a PhD student at Sydney University, studying biography writing. During National Pain Week 2021 and the Global Year of Back Pain, Painaustralia shared her biography of Dr. Michael Cousins AO – Breaking Through the Pain Barrier: The Extraordinary Life of Dr. Michael J. Cousins.
Photo credit: © stock.adobe.com / au / New Africa