Minimally Invasive Spine And Pain Interventions (mipsi) Are Going To Be Game Changers In The Healthcare Industry

By Author: Pankaj Surange
Total Articles: 10
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Pain medicine is a discipline of medicine that deals with subacute, chronic and intractable, and resistant painful conditions principally with minimally invasive interventional techniques. Acute pain for various conditions is managed by the specialist in that field and perioperative pain is managed mainly by Anesthesiologists.
Interventional techniques are minimally invasive, non-surgical procedures including percutaneous precision needle placement, with the placement of drugs in targeted areas or ablation of targeted nerves; and some surgical techniques for the diagnosis and management of chronic, persistent, or intractable pain such as laser or endoscopic discectomy and spine procedures, Vertebroplasty, intrathecal infusion pumps, and spinal cord stimulators. (1)
There is overwhelming evidence showing an association of chronic pain with significant economic, societal, and health outcomes. (2,3) With the increasing geriatric population and even more alarming, the young population getting affected with chronic pain. A study from across 42 countries identified that self-reported chronic pain amongst adolescent populations ...
... was common: 20.6% of young people experienced pain in at least two sites headache, stomach, and backache. Chronic pain affects up to 30% of those aged 18–39 yr. (4)
A survey conducted by the Indian Society for the study of pain showed 43% of patients with chronic pain consulting pain physicians belong to the young age group between 25-45 years of age. Further, along with enormous costs and disability associated with reduced functioning, overuse of opioids and related fatalities have been well described. (5,6,7) Severe and chronic pain can impair mobility and function as well as reduce the general quality of life, thereby posing barriers to human flourishing and productivity.
Prevalence of Chronic pain worldwide.
According to a study published by the National Centre for Biotechnology Information (NCBI) in 2015, around 19.6% of individuals aged between 20 to 60 years were suffering from low back pain worldwide. (8)
According to a study published by the Centres for Disease Control and Prevention (CDC) in 2012, around 20.3% of the population in the U.S. suffer from lower back pain. As per the report of the American Academy of Pain Medicine (AAPM) 2012, over 100 million people suffer from chronic pain, 25.8 million from diabetes, 16.3 million from coronary heart disease, and 11.9 million from cancer in the U.S. every year, which is expected to further increase in the near future. Moreover, in 2015, the National Institutes of Health (NIH) estimated that one in 10 people in the U.S. suffers from chronic pain. According to a study published in the British Medical Journal in 2016, around one-third to half of the population in the U.K. suffers from chronic pain.
Prevalence of Chronic pain in India and its impact.
The prevalence of chronic pain (CP) is well described in Europe, America, and Australia.
Approximately 30% of the world's population suffers from pain. Various regional pain surveys' reliable estimates indicate that the CP prevalence is somewhat closer to 30%–40%. (9)
A prevalence study published in the Indian Journal of Palliative care shows a huge chronic burden in India with a prevalence rate of 19.3%, which translates into 180–200 million adults having CP (10). Thirty-six percent of respondents were not able to do their routine work due to pain. 25.5% had accepted pain as part of their lives. 14.1% of respondents had anxiety and depression due to CP. Since low- and middle-income countries’ population largely depends on the government healthcare system for low-cost treatment, this prevalence study shall play an important role to emphasize on government and administrative agencies the unmet need for proper budget allocation, and organizing management plan for pain management at different healthcare levels.
Musculoskeletal disorders, pain related to operations and injuries, and spine problems represent the largest global burden of pain, with low back pain being the leading cause of years lived with disability worldwide and prohibiting physical activities (11).
The World Health Organization estimates that 80% of patients with severe pain never receive any adequate treatment. The World Health Organization predicts that by 2030, chronic pain will be an important co-morbidity of the four leading causes of the global burden of disease (12)
Unmanaged pain also has a tremendous economic impact and vice versa, both at the individual and societal levels. A European study shows that 61% of chronic pain sufferers were less able or unable to work outside the home, and 19% lost their jobs due to pain (13).

Cost Effectiveness of Minimally Invasive Interventions for Sub-Acute and Chronic Pain
Based on clinical experience we hypothesize that for patients with chronic pain, minimal interventional procedures will be more effective than a program without these procedures.
The main effect is not only pain reduction, but this will be associated with improved functioning and quality of life. The costs of minimal interventional procedures are approximately half to one-third of surgical procedures. We understand that the average costs of patients who receive minimal interventional procedures are higher than those of patients managed conservatively. However, when clinical outcomes are better, minimal interventional procedures are cost-effective if the incremental costs are worthwhile. Also, improved clinical outcomes and more rapid recovery results in less additional health care consumption and lower costs of work absenteeism and consequently lower additional costs. This is especially important for the younger population.

Future
The rising prevalence of #chronic pain is expected to increase the demand for interventional pain management techniques for its treatment, thereby fuelling interventional pain management market growth in the near future.
Most of the market surveys have predicted significant growth in the field of Interventional Pain management and the demand for these techniques for the next 5 years (2018-2023).
Indian doctors have already shown their potential in managing chronic pain patients and patients from this part of the world have tremendous faith in Indian Doctors and pain physicians because of their ethical practice and expertise in this field. With this background, India can take a lead role in medical tourism to attract patients with chronic pain from this part of the world.

References:

1. Medicare Payment Advisory Commission Report to Congress. Paying for Interventional Pain Services in Ambulatory Settings. December 2001.
2. Trends in health care expenditures, utilization, and health status among US adults with spine problems, 1997 -- 2006. Spine (Phila Pa 1976) 2009; 34:2077- 2084.
3. The societal costs of low back pain: Data published between 2001 and 2007. J Pain Palliate Care Pharmacother 2007; 21:25-33.
4. Prevalence of self-reported chronic pain among adolescents: evidence from 42 countries and regions. Eur J Pain. 2019 Feb;23:316–326.
5. American Society of Interventional Pain Physicians (ASIPP) guidelines for responsible opioid prescribing in chronic non-cancer pain: Part I – Evidence assessment. Pain Physician 2012; 15:S1-S66.
6. Centers for Disease Control and Prevention. CDC grand rounds: Prescription drug overdoses – a U.S. epidemic. MMWR Morb Mortal Wkly Rep 2012; 61:10-13.
7. Opioid epidemic in the Unit- ed States. Pain Physician 2012; 15:ES9-ES38
8. Revista de saude publica 49:1-10 · October 2015
9. Anesth Analg. 2016;123:739–48.
10. Indian J Palliat Care. 2018 Oct-Dec; 24(4): 472–477
11. Boutevillain, 2017, Vos et al., 2012
12. van Hecke, Torrance, & Smith, 2013
13. van Hecke, Torrance, & Smith, 2013