<span style="font-size: 14.6667px;">The Pain Management Unit at the Aga Khan University Hospital (AKUH) has introduced Neuromodulation procedure for treating patients who have chronic pain and disability. The hospital is the first in East Africa to use this mode of treatment performed on 43 patients by a multidisciplinary team of specialists who included pain medicine specialists, neurosurgeons pain management therapists and psychologists from the hospital.</span><br style="font-size: 14.6667px;"/><br style="font-size: 14.6667px;"/><span style="font-size: 14.6667px;">The procedure is used as a last resort for both cancer and non-cancer patients when all other modes of treatment have failed. In addition, this treatment procedure is performed on patients who have been suffering from persistent pain for a period of at least two months with the underlying cause not having been found. </span><br style="font-size: 14.6667px;"/><br style="font-size: 14.6667px;"/><span style="font-size: 14.6667px;">Dr Thikra Sharif, Pain Medicine Specialist and head of the Pain Management Unit at Aga Khan University Hospital, said, “Chronic pain that is undiagnosed, or untreated leads to disability and loss of proper functioning. This has a negative impact on a patient’s quality of life resulting in other illnesses such as depression, severe anxiety and consequently disability and loss of productivity. In such cases pain killers are ineffective and treatment requires a multidisciplinary team of specialists including neurosurgeons, pain management therapists and psychologists."</span><br style="font-size: 14.6667px;"/><br style="font-size: 14.6667px;"/><span style="font-size: 14.6667px;">“First, a comprehensive assessment is carried out on a patient by at least three members of the team depending on the patient’s pain condition. Thereafter, the specialists conclude the diagnosis and develop a treatment plan that is specific to a patient with the objectives of controlling pain, improving function and managing disability. This can be oral medication alone, or include intervention of other procedures. In some cases a patient may need the help of a psychologist, or orthopaedic surgeon”.</span><br style="font-size: 14.6667px;"/><br style="font-size: 14.6667px;"/><span style="font-size: 14.6667px;">Explaining the three processes of Neuromodulation, Dr Thikra said, “Spinal Cord Stimulator (SCS) involves implanting a fine soft wire with electrical leads on its tip placed through a needle in the back close to the spinal column. A small incision is then made and a tiny, programmable generator with batteries that can last up to seven years placed in the upper buttock, or abdomen under the skin. This emits electrical currents to the spinal column which block pain signals hence giving relief to a patient.”</span><br style="font-size: 14.6667px;"/><br style="font-size: 14.6667px;"/><span style="font-size: 14.6667px;">“This method is used for non-cancer patients with fail back syndrome, a condition caused by several back surgeries leading to trauma. Although the pain may be eliminated, normal functionality can be lacking hence after the procedure, a patient is taken through a treatment programme that is unique to him, or her.”</span><br style="font-size: 14.6667px;"/><br style="font-size: 14.6667px;"/><span style="font-size: 14.6667px;">“There is a six week ADAPT programme and a long term neuro rehabilitation programme for patients with advanced disability, post stroke disability and disability due to multiple traumas. Consequences of pain can be worse than the pain itself thus a comprehensive plan is necessary to help patient’s live improved and productive lives.”</span><br style="font-size: 14.6667px;"/><br style="font-size: 14.6667px;"/><span style="font-size: 14.6667px;">“Second, there is Sacral Neuromodulation Stimulator (SNS) used to treat pelvic pain in males and females. The pain is common to patients who have undergone rectal surgery, or radiotherapy causing bowel dysfunction, or incontinence. Patients living with this condition are more prone to depression due to the nature of the disease.”</span><br style="font-size: 14.6667px;"/><br style="font-size: 14.6667px;"/><span style="font-size: 14.6667px;">Describing the procedure Dr Thikra said, “Along the spinal cord and through the lower back there is the sacral area. Here, nerve paths split off and go in different directions, some to the pelvic area. The muscles in the pelvic area, such as the pelvic floor, urethral sphincters, bladder and anal sphincter muscles are controlled by the brain through nerves that run from the sacral area.” </span><br style="font-size: 14.6667px;"/><br style="font-size: 14.6667px;"/><span style="font-size: 14.6667px;">“Sensations such as fullness in the bladder, or rectum are also relayed to the brain via these nerve routes. Sacral neuromodulation may help to correct inappropriate, unwanted, or even erroneous messages sent along these nerve pathways.”</span><br style="font-size: 14.6667px;"/><br style="font-size: 14.6667px;"/><span style="font-size: 14.6667px;">"Lastly is Intrathecal nerve stimulator (INS), used for the management of spasticity which is caused as a result of injury to the neural tissue inside the cord after surgery. A person may be paralysed, but undergoing enormous pain.”</span><br style="font-size: 14.6667px;"/><br style="font-size: 14.6667px;"/><span style="font-size: 14.6667px;">In conclusion, Dr Thikra said, “Treatment of chronic pain can take between six weeks to six years depending on the patient’s level of impairment in relation to chronic pain. In some conditions, the pain cannot be completely eliminated, but the patient management also includes therapy that will help to control the pain to a minimal level in which the patient is reasonably functional and productive.”</span><br style="font-size: 14.6667px;"/><br style="font-size: 14.6667px;"/>
