Which treatment is best for patients?
Dr. Ken Follet: The basic choice between neurostimulation and intrathecal drug delivery hinges on the type of the pain, is that nociceptive tissue pain or is it neuropathic pain from nerve injury.
Secondly, we have to think about where the pain is located. If pain is in an extremity, it tends to be much more amenable to treatment with neurostimulation compared to pain that affects the trunk or abdomen, which is more difficult to treat with neurostimulation. Intrathecal drug delivery on the other hand, which is very effective for nociceptive pain can be used to treat pain in almost any part of the body.
Dr. Nagy Mekhail: If everything is equal, you have the same patient with the same problem, we would like to start with neurostimulation first. Because it doesn't -- I don't administer any chemicals in the spine. I can view the neurostimulation like on and off switch. You can turn it on, you can turn it off without any damage of chemical administration. With that said, the neurostimulation is more appropriate for neuropathic pain. The intrathecal drug delivery is more appropriate in general of nociceptive pain, but the indications can cross very well.
Dr. Ken Follet: The risks associated with neurostimulation therapy are extremely small. There are risks with every surgical procedure and surgery is required to implant the device, but the surgery is very straightforward. It's relatively noninvasive. The risk of complication of surgery is less than a few percent.
Once the device is implanted and working well, the likelihood of a complication is almost nonexistent. The risks associated with intrathecal drug delivery are related to the surgery involved to implant upon. Again, the surgery is very simple, it's very safe, very unusual to have a complication, but there are also risks potentially associated with the medications that are used.
As with medications given in any other form, whether it's by mouth or through the vein, people can have side effects to the medications. For example, if we deliver morphine into the spinal fluid, they may have constipation, they may have itching, they may have some trouble with urination. Typically, those side effects are temporary and resolve as we adjust the dose to a proper level. The risk of serious side effects is extremely low.
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