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Six and a half years ago, Elizabeth Ruddick, now 21, rolled her ankle playing Frisbee. A longtime athlete, Ruddick assumed it would heal just like any of the other sports injuries she’d dealt with in the past. “I thought that for the next nine months,” she says. “But it just kept getting worse.”
Fast-forward more than five years, and the pain was still getting worse, despite Ruddick’s visits to sports doctors, physical therapists and multiple pain medicine physicians across the country who gave her prescriptions, spinal cord blocks and injections that took away her short-term memory in hopes that her body would “forget” the pain. She was forced to postpone college and quit her job working at the library, and instead spent her time visiting hypnotists, cognitive behavioral therapists and psychologists to try to cope with both the physical pain and its emotional impact on her life.
She went from playing soccer to walking with crutches, and eventually to getting around in a wheelchair. Even getting out of bed to the chair was a challenge, since the pain had spread from her right ankle to debilitate both legs and arms. She couldn’t focus long enough to hold a conversation or read a book, and she regularly passed out from the pain.
Eventually, doctors explained that Ruddick was suffering from complex regional pain syndrome, or CRPS, a hard-to-treat condition that – similar to other chronic pain syndromes – may result from damage to the nervous system. “It got more and less intense,” she says, “but it was always there.”
Twin Epidemics
Ruddick is among the 25.3 million U.S. adults who suffer from chronic pain, which can occur post-trauma if the injury heals but the brain still receives nerve signals it interprets as pain, explains Dr. Timothy R. Deer, clinical professor of anesthesiology and pain medicine at the West Virginia University School of Medicine and president of the International Neuromodulation Society. More than 23 million additional Americans experience “severe pain” on a regular basis, research suggests.
But treating this population introduces another problem: While opioids such as oxycodone, hydrocodone, codeine and morphine are routinely prescribed to treat chronic pain because they interact with nerve cells in the body and brain to reduce pain perception, as many as 1 in 4 people who take prescription opioids over the long term struggle with addiction, according to research published in the journal Addiction.
The opioid epidemic is so bad, in fact, that it’s been declared a national emergency, with the Centers for Disease Control and Prevention reporting that, from 1999 to 2015, more than 183,000 Americans died from overdoses related to prescription opioids. In 2015 alone, more than 15,000 people took fatal overdoses of prescription opioids.
Beyond Opioids
In the fight against both chronic pain and opioid overuse, technological advances are making a form of neurostimulation called spinal cord stimulation, or SCS, a once-fringe treatment first developed in the 1960s, increasingly more effective – and poised to become a mainstay in chronic pain treatment.
In SCS, clinicians implant electrical leads along a patient’s spinal column to deliver electrical impulses to nerve fibers and interrupt pain signals on their way to the brain. It’s like a pacemaker for the sensory system, resetting it to read what it thought was “pain” to what it really is: fine. The patient uses an external remote to control the device’s settings.
Research presented at the annual meeting of the American Academy of Pain Medicine shows that SCS reduces pain by an average of 75 percent in patients who receive treatment within two years of developing chronic pain, while 2017 Abbott-supported research demonstrates that SCS can also help significantly lower the use of opioids in chronic pain patients. Different forms of SCS are advised for different chronic pain conditions, ranging from CRPS to low-back pain to diabetes-related neuropathy.
Mounting research shows that the evidence for spinal cord stimulation is better than that for opioids and surgeries, according to Deer. He also notes that, apart from often being effective in chronic pain patients who haven’t found relief with these more-common therapies, SCS is often a less-expensive alternative. Better yet? Patients can give it a test run before receiving an implant.
Living Again
It wasn’t until the spring of 2016 that anyone recommended Ruddick try out SCS. “I felt the spinal cord stimulation was a great option for her to regain functionality and quality of life,” explains Louisville-based Dr. Brandon M. Sutton, a diplomate of the American Board of Anesthesiology with a subspecialty certification in pain management.
But after trialing SCS, noticing a 60- to 70-percent reduction in pain and scheduling an appointment to implant the permanent device, Sutton offered Ruddick, who lives in Colombus, Indiana, an even more appealing option: the Axium Neurostimulator System, a new neurostimulation device that received FDA approval for treatment of CRPS in February 2016. Unlike traditional SCS, which works well for widespread pain, the Axium system, which Abbott launched in April 2016, stimulates the dorsal root ganglion, a spinal structure rich with sensory nerves that transmit information to the brain via the spinal cord. By doing so, it’s able to pinpoint the specific areas of the body affected by very targeted pain associated with CRPS. This allows the device to decrease pain signaling while using less electrical energy than other neurostimulation therapies, explains Dr. Allen W. Burton, medical director of Neuromodulation, Movement Disorders and Pain at Abbott.
After only a few days into her trial, Ruddick was set on dorsal root ganglion, or DRG, therapy. She scheduled an appointment to give Sutton the verdict. “When I walked into the room, it was staggering,” Sutton says. “When I first met her, she was curled up on the bed and barely spoke. That day, she was sitting up, laughing.”
Three weeks later, on September 12, 2016, Sutton implanted the device – just in time for Ruddick to walk down the aisle as maid of honor at her sister’s wedding. “Life is a lot better,” says Ruddick, who is still recovering but can swim as a way to rebuild strength, cook, take her puppy outside and visit with friends when the pain allows. “Overall, I’m just really excited with where my life is going,” she says. “It’s a long time since I had been able to say that.”
Written for US News and World Report