For 11 years, Sarah Graff walked with a cane to help ease the debilitating pain in her leg. No longer. Today she walks freely, swims and has returned to something she never expected to do in middle age, her passion as a youth – ice skating.
Graff credits innovations in pain treatment for her new lease on life: “Medical technology is incredible nowadays – there are so many new options worth trying.”
Here, we spotlight innovations to help predict, prevent and manage pain. Some are available now – such as the implantable electronic device that empowered Graff to get control over her pain – while others are in development, promising near-term advancements and breakthroughs.
Brain scans for personalized treatment
One of the biggest challenges for those living with pain is the trying journey to an effective therapeutic solution, since chronic pain is often considered an “invisible” disease.
But by using an advanced technique called functional magnetic resonance imaging (fMRI), healthcare providers may soon be able to help patients find their best option for relief faster and reduce exhausting trial and error.
Unlike a regular MRI, which produces a detailed image of the brain’s structure, an fMRI also maps areas of the brain and their activity. Dr. Karen Davis, head, division of brain, imaging and behaviour-systems neuroscience at the Krembil Brain Institute in Toronto, has investigated differences in brain activity in people as they performed challenging tasks while receiving pain stimuli.
Her research has revealed the potential for fMRI as a predictive tool for pain tolerance. It could also identify brain-based biomarkers for pain and its various types to then help suggest best courses of action.
“If we can prevent somebody from undergoing multiple treatments that are time-consuming, costly, exhausting and don’t work, and get them more quickly to the treatment that does work, then that’s great for the patient,” says Dr. Davis.
New-generation spinal implants
A device under her skin that stimulates her spinal cord has allowed Sarah Graff to be more engaged in life for the first time in more than a decade. A figure skater in her youth, she had undergone surgery to realign her shinbone in her landing leg. Unfortunately, her nerves were damaged during the surgery, and Graff was diagnosed with complex regional pain syndrome.
The pain in her leg was often excruciating, and for 11 years Graff was on a cocktail of drugs (including morphine) that left her feeling foggy. She also needed to walk with a cane. In 2016, she was identified as a candidate for an implantable spinal-cord stimulator (SCS) – a device that uses electrical currents to block pain signals before they reach the brain.
This is a try-before-you-decide solution; spinal-cord stimulation can be trialled without needing an implant. The impact was like day and night for Graff. “Tears were coming out of my eyes as soon as I tested it; I knew that this would be the life-changer I needed,” she says. “I felt almost immediate relief.”
An advanced SCS system from Medtronic was surgically implanted in Graff’s back near her spinal cord. Unlike older SCS systems, Medtronic’s is safe to wear inside an MRI. (A recent study showed 82 percent of SCS-implanted patients would need at least one MRI within five years of implant, making this solution previously less than ideal for most.)
In April 2018, the medical device manufacturer also received licence from Health Canada for the world’s smallest SCS – called Intellis – in the management of chronic, intractable pain of the trunk and limbs.
Graff uses a handheld device to control the system. The implanted device also includes technology that adjusts the therapy as the body moves. “I just came back from Great Wolf Lodge and was able to run around and be in the water pain-free,” says Graff, who runs a home daycare in Brantford, ON. “I’ve also got back on the ice to skate, and to not feel the pain has been incredible.”
Pharmacy aisles are lined with over-the-counter (OTC) pain relievers containing acetaminophen as the active ingredient. Think Tylenol and Excedrin. Researchers still aren’t sure exactly how acetaminophen works, but a 2018 study from researchers at John Hopkins University shows patients may be underutilizing OTC medications.
According to the research, people may not be aware just how effective these drugs can be for their acute or chronic pain. Aside from OTC medicines with acetaminophen, OTC options include:
- A portable device that delivers transcutaneous electronic nerve stimulation (TENS) – low-voltage electrical impulses via electrode pads placed on the skin. A relatively new innovation, researchers think TENS “distracts” the brain from the pain and boosts production of endorphins, the body’s natural painkillers. [Linda, can we show three options from Wellwise? https://www.wellwise.ca/search?term=TENS]
- NSAIDs (non-steroidal anti-inflammatory drugs) that work to disrupt the production of prostaglandins involved in pain and inflammation. They include Ibuprofen, Naproxen and Voltaren, which also comes as a topical gel. Studies have shown it to be a good option to try for acute muscoskeletal pain. “It can take the edge off,” says Dr. Jason Busse, associate professor at McMaster University’s department of anesthesia. “People with chronic pain can get caught in a vicious cycle – the pain prevents them from doing certain activities that boost their mood, and so they become deconditioned to the point that even everyday activities become painful to do.”
“Ideally, what you want from an OTC product is enough relief to get active, because getting stronger and healthier has shown to help with pain,” says Dr. Busse. In other words? Try to break the cycle.
There’s an app for that
Many Canadians already use their mobile devices to help manage their health, from apps that turn it into a pedometer to sending medication-taking reminders. Apps can also help with pain management.
Vancouver-based eTreatMD, an AGE-WELL-supported health start-up, has developed an app, LiveWith Arthritis Plus, which has been approved by Health Canada as a Class II medical device. Now available for download, it is also PIPEDA- and HIPAA-compliant.
The app uses the imaging technology of smartphones to measure changes to the joints in the hand and tracks the different factors that can contribute to flare-ups, from diet and activity to stress and weather. This empowers users to give physicians a wider picture of their hand inflammation and anatomical changes over time. Alissa Taylor, marketing director, eTreatMD, says, “This can lead to better treatment outcomes and also help empower patients to better understand their pain and play an active role in getting better.”
In recognition of eTreatMD’s innovation, the Arthritis Society nominated the developer for the Canadian Advanced Technology Alliance’s Telus Health product achievement award in 2016. The two organizations have since collaborated on a number of cause marketing and awareness initiatives. Bruce Watson, the Arthritis Society’s director of fund development, says the goal is to leverage technology to help solve problems for people living with the daily challenges of arthritis, while generating research funding to fuel the Arthritis Society’s quest for a cure.
Giving voice to pain
Advancements are also being made that give voice to patients with severe limitations on their ability to communicate their pain. For instance, AGE-WELL and the Canadian Institutes of Health Research are funding a project led by Dr. Thomas Hadjistavropoulos, a professor and research chair in aging and health at the University of Regina, on facial recognition software for automated pain detection.
He and his team have been coding non-verbal pain expressions from more than 1,060,000 frames of video to produce an algorithm. This algorithm could power a system of cameras in long-term care facilities that would alert staff when someone with Alzheimer’s disease and other forms of dementia is in pain, based on facial cues. (The cameras wouldn’t record, however, to protect patient privacy.)
With this technology, someone who develops a tooth abscess, for instance, wouldn’t go days, or even weeks, without being treated for the pain. “This group is very much untreated when it comes to pain – as high as 80 percent of them,” notes Dr. Hadjistavropoulos. This would bring relief to patients and also peace of mind for loved ones and their caregivers.
This article originally appeared in Issue 4 of YouAreUNLTD magazine.