The International Neuromodulation Society (INS) recently held its 3rd Annual Scientific meeting of its Australian chapter at the Perth Convention Centre in Western Australia. The conference, held on 30th March 2008 was part of the 28th Annual Scientific Meeting of the Australian Pain Society. The theme for this years meeting, Neuromodulation: Technology at the Neural Interface, continued on from the international meeting held in Acapulco, Mexico in December last year. The conference was attended by pain specialists and scientists from around Australia and featured some recent developments in the use of spinal cord stimulation (SCS) for refractory angina and successful results from research studies using spinal analgesic combination chemotherapy. The application of the innovative technology of virtual reality in the managment of pain conditions was presented by a special guest speaker, Professor Maureen Simmonds from McGill University in Montreal, Canada.
An update on the recent developments and challenges faced with the use of spinal cord stimulation (SCS) as a treatment for refractory angina was discussed by Dr Max Majedi, an anaesthesia and pain specialist from Sir Charles Gardiner Hospital in Perth. SCS can reduce the frequency and intensity of angina and randomised control trials (RCT) have demonstrated the efficacy of this treatment in improving quality of life, exercise tolerance and in reducing intake of medication. Dr Majedi reported on studies that have shown this treatment to be a cost-effective option which can also reduce the risk of death and hospitalisation admission rates. Additionally, the procedure is much less invasive than conventional revascularisation therapies such as coronary artery bypass grafting (CABG). He emphasised the role of SCS as a possible treatment option in patients with poor surgical outcomes and those who still have symptoms despite having undergone revascularisation therapy. However, it was pointed out that considerable challenges are being faced in terms of funding, programming and the reluctance of patients as well as cardiologists to utilise this procedure. The importance of education on informing those involved of the benefits of this procedure in the treatment of refractory angina was emphasised.
One of the highlights of the meeting was the presentation by Professor Maureen Simmons from McGill University of a novel rehabilitative approach in pain management through the use of visual field immersion and virtual reality (VR). This interactive, computer based, multisensory simulation technology has been shown to be effective in reducing pain symptoms, improving mood and enhancing movement in patients suffering from various pain conditions. Her innovative approach revolves around the relationship between pain, mood and movement. By using the virtual environment this simulation technology allows patients to interact in real time using their natural senses and skills. In positively influencing mood, patients are motivated to increase their movement, as any movement is beneficial for the management of pain. By creating a distraction, the experience of visual field immersion can reduce the intensity of the perceived pain. Some promising studies were presented where VR was used to reduce pain and improve function in burn victims, cancer patients and patients with post stroke pain. The potential of VR in exploring fear and reducing anxieties by placing patients in environments which normally elicit fear responses was also highlighted.
Dr Marc Russo introduced the concept of spinal analgesic combination chemotherapy, that is, the intra-spinal administration of a combination of analgesic agents which can potentially improve efficacy through synergistic mechanisms. He explained the concept of additivity and synergism between drugs which could be assessed graphically using an isobologram. Opioids such as morphine are strongly synergistic with clonidine and bupivicaine. Dr Russo presented data from his Hunter Clinic showing the effectiveness of this approach where functional outcome and pain scores were found to be much improved in patients receiving a mixture of multiple analgesic agents. The importance of this is the potential of being able to use lower doses of multiple drugs that act synergistically. However he emphasised the need for further studies to assess the efficacy, safety and potential for granuloma formation in using such combination drug therapies.
Overall the conference was a success providing insights into new therapies and developments in the field of neuromodulation.
- International Neuromodulation Society abstract book from the 3rd Annual Scientific Meeting of the Australian Chapter of the International Neuromodulation Society. Perth Convention Centre 30 March 2008.
- Lee AW & Pilitsis JG. Spinal cord stimulation: indications and outcome. Neurosurgery focus 2006; 21 (6); E3.1-6.