Manohar Sharma Spotlight
Pain Neuromodulation
The Walton Centre has been involved in Reactiv8 Implant to strengthen the back muscles (multifidus muscles) to improve chronic lower back pain. This implantable device includes a wire (lead) with electrodes stimulating nerves controlling the back muscles. These wires are powered by an implanted battery which last about 5 years. We now have prospectively collected outcome data over 24 months in 12 patients. Overall there has been a positive outcome in several patients with an improved level of pain, physical activity and satisfaction with the treatment. In these cases otherwise pain relief options are limited. Another large multicenter randomized sham controlled trial has now demonstrated significant improvement in lower back pain comparing active treatment with Reavtiv8 implant. Therefore the Food and Drugs Administration (FDA) has given approval for Reactiv8 Implant to be used to help mechanical back pain as a safe and clinically effective treatment. This new treatment is now available in the UK on the National Health Service in several leading pain clinics. The Walton Centre is currently working on developing a patient care pathway to implement this highly specialized treatment by selecting appropriate cases that are likely to benefit most from this new implantable treatment to help sufferers of chronic mechanical lower back pain.
A number of other research projects on spinal cord stimulation technique with other pain units are awaiting resumption of research activity due to COVID-19 pandemic.
Cancer Pain
2020 had an excellent start for the year with organization of an interdisciplinary study day to treat refractory cancer pain with neuroablative techniques. Around 50 national and international delegates attended to share their expertise. Live videos of interventional cancer pain techniques including cordotomy, spinal neuroablative blocks and neurosurgical techniques including thalamotomy were presented. The focus was on practical technical aspects so that delegate can refine their skills as otherwise opportunities to learn are scarce. This generated huge interest and discussion benefitting all attendees. The Faculty was from across the world and some presenting via remote video link.
The National Cervical cordotomy Registry for which The Walton Centre contributed the data for the last several years has now been published with the outcomes showing significant improvement in pain as well as significant reduction in the amount of pain killers required to manage refractory pain with better quality of life. The Walton Centre has published its own prospective outcome results following cordotomy for the period of two years with multimodal evaluation.
Another ongoing study with cervical cordotomy is evaluating the neurophysiological effects of cordotomy to correlate with structural lesion location and size with pain relief demonstrated by the patients.
The award winning Cancer Pain Handbook is undergoing further update for the second edition and is due for publication by Oxford University Press in 2021.
Spinal pain
A large multicenter randomized trial (NERVES trial) comparing clinical outcomes and cost effectiveness following surgical microdiscectomy and nerve root injection (epidural) has concluded. In a large series of cases with persistent sciatica of less than 12 month duration has demonstrated significant surgery sparing benefit of nerve root epidural steroid injections over 12 months evaluation period. The study has now been submitted for publication and is likely to influence national pathway for management of sciatica.
Another large multicenter trial to evaluate clinical and cost effectiveness of lumbar denervation (RADICAL trial) is about to start and is in the initial stages. There has been some delay due to the COVID19 pandemic. However, this study is likely to be a key in the field of pain medicine to assess the utility or lack of utility of lumbar radiofrequency denervation treatment for back pain which is currently offered as a routine on the National Health Service but is under threat of decommissioning due to concerns over its evidence. My contribution to publications over the last 12 months can be viewed on our publications section