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Physicians have long been interested in approaches to chronic pain management that are less prone to abuse than traditionally prescribed medications. But the ongoing opioid crisis in America has shone a light on how a combination of increased heroin use, dubious prescription and pharmaceutical practices, and the increased amount of fentanyl drug dealers have added to heroin have combined to impale tens of thousands of additional people on a yearly basis. There'southward a real trouble growing in America, and new treatments for chronic pain could potentially address information technology, via drug delivery implant systems and intrathecal electrical stimulation.

Before we dive into the science of these new systems, it's of import to get a sense for the calibration of the crisis. The graph higher up runs only through 2015, but early data suggests that 2016 fatalities rose 19 percent over the 52,404 recorded deaths in 2015. The death rate throughout 2017 already suggests this year volition be even worse.

The medical establishment's flawed response

Faced with a growing problem, states and the medical establishment have responded in a variety of ways. Some states take tightened the rules around opioid prescriptions, equally take many doctor groups and manufacture organizations.

On the one paw, this increased policing of patient drug use makes sense. Spiking mortality rates in heroin and fentanyl since 2010 have driven much of the recent increase, but opiate bloodshed rates have been rising in line with prescription rates since 2000. Some have argued that our increased reliance on opiates for chronic pain management tin exist ultimately traced to a five-sentence letter published in the New England Journal of Medicine in 1980.

Simply on the other hand, treating all patients like drug-seeking addicts is precisely the wrong response. There are tens of millions of Americans who are older or on disability. Retired blue-collar workers who worked on factory lines or in physically enervating jobs for decades face up real challenges in chronic hurting management.

New York recently passed a law called ISTOP, ostensibly aimed at curbing the opioid corruption epidemic by cutting off the supply of opioids given to doctor-shoppers. It made all prescriptions electronic, and added an extra step for wellness care practitioners to look up patients in the "did this patient always use a narcotic or other scheduled drug" database. So while the addictive potential of opiates is fueling this crisis, there'southward a critical need for pain maintenance systems that don't require doctors and patients to view each other through a web of suspicion and distrust.

NYS instituted a law that not just curbs abuse (which is first-class), only besides inconveniences literally anyone who seeks hurting medication — and anyone else unlucky enough to be defenseless upward in the dragnet.

We've previously discussed i potential method for dealing with chronic pain management that would obviate this trouble. Last year, the FDA canonical an implant that administers a controlled dose of the painkiller buprenorphine at a constant, steady rate. These implants are similar to the nascence command implants like Nexplanon, which women have used for years. The implants tin can maintain a steady blood serum concentration that even carefully regulated oral dosing from careful patients struggles to match.

Because the level of pain killers in the claret remains steady, patients don't experience a waxing or waning consequence from their medication. And implanting the drug in the torso in a long-term distribution system removes any possibility of abuse.

At that place are existing methods for delivering medication to the spinal column via an intrathecal pump, simply such pumps are expensive and require surgery to implant. A Nexplanon-like implant, in dissimilarity, could be injected at a doctor's office through a needle; no surgery at all. And so suddenly yous don't have to become to bed wondering if you'll wake up in hurting so intense y'all won't be able to sit upwardly and reach your pain meds.

The other potential option for chronic pain management that wouldn't rely on opiates or drugs is a spinal string stimulator. These devices share some commonalities with the brain control implants nosotros've discussed in other stories, and they function as described: by sending a balmy electric pulse into the spinal column. The electrical pulses "modify and mask the hurting signal from reaching your brain."

Credit: Mayfieldclinic.com

SCS doesn't work for all patients, and information technology doesn't generally completely eliminate pain, with a 50-seventy percentage reduction considered a stiff consequence. It'south not a perfect solution (like an intrathecal pump, an SCS requires surgery), and the ability of the device to reduce hurting varies significantly depending on the crusade of the status.

Yet, betwixt implant systems, SCS, intrathecal pumps, and fifty-fifty BCIs, we're seeing some positive motility on this front. Given the rapid increase in opiate dependency, and an aging population of Boomers with chronic pain challenges, treatments that don't rely on opiates or create conflict between doctors and patients tin't make it quickly enough.

Top image credit: Probuphine implant, Braeburn Pharmaceuticals