Evidence doesn’t support spinal cord stimulators for chronic back pain – and they could cause harm
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In an episode of ABC’s Four Corners this week, the use of spinal cord stimulators for chronic back pain was brought into question.
Spinal cord stimulators are devices implanted surgically which deliver electric impulses directly to the spinal cord. They’ve been used to treat people with chronic pain since the 1960s.
Their design has changed significantly over time. Early models required an external generator and invasive surgery to implant them. Current devices are fully implantable, rechargeable and can deliver a variety of electrical signals.
However, despite their long history, rigorous experimental research to test the effectiveness of spinal cord stimulators has only been conducted this century. The findings don’t support their use for treating chronic pain. In fact, data points to a significant risk of harm.
What does the evidence say?
One of the first studies used to support the effectiveness of spinal cord stimulators was published in 2005. This study looked at patients who didn’t get relief from initial spinal surgery and compared implantation of a spinal cord stimulator to a repeat of the spinal surgery.
Although it found spinal cord stimulation was the more effective intervention for chronic back pain, the fact this study compared the device to something that had already failed once is an obvious limitation.
Later studies provided more useful evidence. They compared spinal cord stimulation to non-surgical treatments or placebo devices (for example, deactivated spinal cord stimulators).
A 2023 Cochrane review of the published comparative studies found nearly all studies were restricted to short-term outcomes (weeks). And while some studies appeared to show better pain relief with active spinal cord stimulation, the benefits were small, and the evidence was uncertain.
Only one high-quality study compared spinal cord stimulation to placebo up to six months, and it showed no benefit. The review concluded the data doesn’t support the use of spinal cord stimulation for people with back pain.
What about the harms?
The experimental studies often had small numbers of participants, making any estimate of the harms of spinal cord stimulation difficult. So we need to look to other sources.
A review of adverse events reported to Australia’s Therapeutic Goods Administration found the harms can be serious. Of the 520 events reported between 2012 and 2019, 79% were considered “severe” and 13% were “life threatening”.
We don’t know exactly how many spinal cord stimulators were implanted during this period, however this surgery is done reasonably widely in Australia, particularly in the private and workers compensation sectors. In 2023, health insurance data showed more than 1,300 spinal cord stimulator procedures were carried out around the country.
In the review, around half the reported harms were due to a malfunction of the device itself (for example, fracture of the electrical lead, or the lead moved to the wrong spot in the body). The other half involved declines in people’s health such as unexplained increased pain, infection, and tears in the lining around the spinal cord.
More than 80% of the harms required at least one surgery to correct the problem. The same study reported four out of every ten spinal cord stimulators implanted were being removed.
High costs
The cost here is considerable, with the devices alone costing tens of thousands of dollars. Adding associated hospital and medical costs, the total cost for a single procedure averages more than $A50,000. With many patients undergoing multiple repeat procedures, it’s not unusual for costs to be measured in hundreds of thousands of dollars.
Rebates from Medicare, private health funds and other insurance schemes may go towards this total, along with out-of-pocket contributions.
Insurers are uncertain of the effectiveness of spinal cord stimulators, but because their implantation is listed on the Medicare Benefits Schedule and the devices are approved for reimbursement by the government, insurers are forced to fund their use.
Industry influence
If the evidence suggests no sustained benefit over placebo, the harms are significant and the cost is high, why are spinal cord stimulators being used so commonly in Australia? In New Zealand, for example, the devices are rarely used.
Doctors who implant spinal cord stimulators in Australia are well remunerated and funding arrangements are different in New Zealand. But the main reason behind the lack of use in New Zealand is because pain specialists there are not convinced of their effectiveness.
In Australia and elsewhere, the use of spinal cord stimulators is heavily promoted by the pain specialists who implant them, and the device manufacturers, often in unison. The tactics used by the spinal cord stimulator device industry to protect profits have been compared to tactics used by the tobacco industry.
A 2023 paper describes these tactics which include flooding the scientific literature with industry-funded research, undermining unfavourable independent research, and attacking the credibility of those who raise concerns about the devices.
It’s not all bad news
Many who suffer from chronic pain may feel disillusioned after watching the Four Corners report. But it’s not all bad news. Australia happens to be home to some of the world’s top back pain researchers who are working on safe, effective therapies.
New approaches such as sensorimotor retraining, which includes reassurance and encouragement to increase patients’ activity levels, cognitive functional therapy, which targets unhelpful pain-related thinking and behaviour, and old approaches such as exercise, have recently shown benefits in robust clinical research.
If we were to remove funding for expensive, harmful and ineffective treatments, more funding could be directed towards effective ones.
Ian Harris, Professor of Orthopaedic Surgery, UNSW Sydney; Adrian C Traeger, Research Fellow, Institute for Musculoskeletal Health, University of Sydney, and Caitlin Jones, Postdoctoral Research Associate in Musculoskeletal Health, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Antioxidant Matcha Snack Bars
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The antioxidants in this come not just from the matcha, but also the cacao nibs and chocolate, as well as lots of nutrients from the hazelnuts and cashews. If you’re allergic to nuts, we’ll give you substitutions that will change the nutritional profile (and flavor), but still work perfectly well and be healthy too.
You will need
For the base:
- ⅔ cup roasted hazelnuts (if allergic, substitute dessicated coconut)
- ⅔ cup chopped dates
For the main part:
- 1 cup raw cashews (if allergic, substitute raw coconut, chopped)
- ½ cup almond milk (or your preferred milk of any kind)
- ½ cup cacao nibs
- 2 tbsp lime juice
- 1 tbsp matcha powder
- 1 tbsp maple syrup (omit if you don’t care for sweetness)
For the topping (optional):
- 2oz dark chocolate, melted (and if you like, tempered—but this isn’t necessary; it’ll just make it glossier if you do)
- Spare cacao nibs, chopped nuts, or anything else you might want on there
Method
(we suggest you read everything at least once before doing anything)
1) Blend the base ingredients in a food processor until it has a coarse sticky texture, but isn’t yet a paste or dough.
2) Line a cake pan with baking paper and spread the base mix on the base; press it down to compact it a little and ensure it is flat. If there’s room, put this in the freezer while you do the next bit. If not, the fridge will suffice.
3) Blend the main part ingredients apart from the cacao nibs, until smooth. Stir in the cacao nibs with a spoon.
4) Spread the main part evenly over the base, and allow everything you’ve built (in this recipe, not in life in general) to chill in the fridge for at least 4 hours.
5) Cut it into blocks of the size and shape you want to eat them, and (if adding the optional topping) separate the blocks slightly from each other, before drizzling with the chocolate topping. Put it back in the fridge to cool this too; an hour should be sufficient.
6) Serve!
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Which Tea Is Best, By Science?
- Which Plant Milk?
- Why You Should Diversify Your Nuts!
- Cashew Nuts vs Coconut – Which is Healthier?
- Cacao vs Carob – Which is Healthier?
Take care!
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When should you get the updated COVID-19 vaccine?
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Updated COVID-19 vaccines are now available: They’re meant to give you the best protection against the strain of the virus that is making people severely sick and also causing deaths.
Many people were infected during the persistent summer wave, which may leave you wondering when you should get the updated vaccine. The short answer is that it depends on when you last got infected or vaccinated and on your particular level of risk.
We heard from six experts—including medical doctors and epidemiologists—about when they recommend getting an updated vaccine. Read on to learn what they said. And to make it easy, check out the flowchart below.
A flowchart to help you decide when is the best time to get the 2024-2025 updated COVID-19 vaccine. If I was infected with COVID-19 this summer, when should I get the updated vaccine?
All the experts we spoke to agreed that if you were infected this summer, you should wait at least three months since you were infected to get vaccinated.
“Generally, an infection may be protective for about three months,” Dr. Ziyad Al-Aly, chief of research and development at the Veterans Affairs St. Louis Health Care System, tells PGN. “If they got infected three or more months ago, it is a good idea to get vaccinated sooner than later.”
This three-month rule applies if you got vaccinated over the summer, which may be the case for some immunocompromised people, adds Dr. Peter Chin-Hong, professor of medicine at the University of California, San Francisco.
If I didn’t get infected with COVID-19 this summer, when should I get vaccinated?
Most of the experts we talked to say that if you didn’t get infected with COVID-19 this summer, you should get the vaccine as soon as possible. Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine, emphasizes that if this applies to you, you should get vaccinated as soon as possible, especially given the current COVID-19 surge.
Al-Aly agrees. “Vaccine-derived immunity lasts for several months, and it should cover the winter season. Plus, the current vaccine is a KP.2-adapted vaccine, so it will work most optimally against KP.2 and related subvariants [such as] KP.3 that are circulating now,” Al-Aly says. “We don’t know when the virus will mutate to a variant that is not compatible with the KP.2 vaccine.”
Al-Aly adds that if you’d rather take the protection you can get right now, “It may make more sense to get vaccinated sooner than later.”
This especially applies if you’re over 65 or immunocompromised and you haven’t received a COVID-19 vaccine in a year or more because, as Chin-Hong adds, “that is the group that is being hospitalized and disproportionately dying now.”
Some experts—including epidemiologist Katelyn Jetelina, author of newsletter Your Local Epidemiologist—also say that if you’re younger than 65 and not immunocompromised, you can consider waiting and aiming to get vaccinated before Halloween to get the best protection in the winter, when we’re likely to experience another wave because of the colder weather, gathering indoors, and the holidays.
“I am more worried about the winter than the summer, so I would think of October (some time before Halloween) as the ‘Goldilocks moment’—not too early, not too late, but just right,” Chin-Hong adds. Time it “such that your antibodies peak during the winter when COVID-19 cases are expected to exceed what we are seeing this summer.”
My children are starting school—should I get them vaccinated now?
According to most experts we spoke to, now is a good time to get your children vaccinated.
Jennifer Nuzzo, professor of epidemiology and director of the Pandemic Center at the Brown University School of Public Health, adds that “with COVID-19 infection levels as high as they are and increased exposures in school,” now is a particularly good time to get an updated vaccine if people haven’t gotten COVID-19 recently.
Additionally, respiratory viruses spike when kids are back in school, so “doing everything you can to reduce your child’s risk of infection can help protect families and communities,” says epidemiologist Jessica Malaty Rivera, science communications advisor at the de Beaumont Foundation.
For more information, talk to your health care provider.
(Disclosure: The de Beaumont Foundation is a partner of The Public Good Projects, the organization that owns Public Good News.)
This article first appeared on Public Good News and is republished here under a Creative Commons license.
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The Five Key Traits Of Healthy Aging
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The Five Keys Of Aging Healthily
Image courtesy of Peter Prato. This is Dr. Daniel Levitin. He’s a neuroscientist, and his research focuses on aging, the brain, health, productivity, and creativity. Also music, and he himself is an accomplished musician also, but we’re not going to be focusing on that today.
We’re going to be looking at the traits that, according to science, promote healthy longevity in old age. In other words, the things that increase our healthspan, from the perspective of a cognitive scientist.
What does he say we should do?
Dr. Levitin offers us what he calls the “COACH” traits:
- Curiosity
- Openness
- Associations
- Conscientiousness
- Healthy practices
By “associations”, he means relationships. However, that would have made the acronym “CORCH”, and decisions had to be made.
Curiosity
Leonardo da Vinci had a list of seven traits he considered most important.
We’ll not go into those today (he is not our featured expert of the day!), but we will say that he agreed with Dr. Levitin on what goes at the top of the list: curiosity.
- Without curiosity, we will tend not to learn things, and learning things is key to keeping good cognitive function in old age
- Without curiosity, we will tend not to form hypotheses about how/why things are the way they are, so we will not exercise imagination, creativity, problem-solving, and other key functions of our brain
- Without curiosity, we will tend not to seek out new experiences, and consequently, our stimuli will be limited—and thus, so will our brains
Openness
Being curious about taking up ballroom dancing will do little for you, if you are not also open to actually trying it. But, openness is not just a tag-on to curiosity; it deserves its spot in its own right too.
Sometimes, ideas and opportunities come to us unbidden, and we have to be able to be open to those too. This doesn’t mean being naïve, but it does mean having at least a position of open-minded skepticism.
Basically, Dr. Levitin is asking us to be the opposite of the pejorative stereotype of “an old person stuck in their ways”.
Associations
People are complex, and so they bring complexities to our lives. Hopefully, positively stimulating ones. Without them to challenge us (again, hopefully in a positive way), we can get very stuck in a narrow field of experience.
And of course, having at least a few good friends has numerous benefits to health. There’s been a lot of research on this; 5 appears to be optimal.
- More than that, and the depth tends to tail off, and/or stresses ensue from juggling too many relationships
- Fewer than that, and we might be only a calendar clash away from loneliness
Friends provide social stimulation and mutual support; they’re good for our mental health and even our physiological immunity (counterintuitively, by means of shared germs).
And, a strong secure romantic relationship is something that has been found time and again to extend healthy life.
Note: by popular statistics, this benefit is conferred upon men partnered with women, men partnered with men, women partnered with women, but not women partnered with men.
There may be a causative factor that’s beyond the scope of this article which is about cognitive science, not feminism, but there could also be a mathematical explanation for this apparent odd-one-out:
Since women tend to live longer than men (who are also often older than their female partners), women who live the longest are often not in a relationship—precisely because they are widows. So these long-lived widows will tend to skew the stats, through no fault of their husbands.
On the flipside of this, for a woman to predecease her (statistically older and shorter-lived) husband will often require that she die quite early (perhaps due to accident or illness unrelated to age), which will again skew the stats to “women married to men die younger”, without anything nefarious going on.
Conscientiousness
People who score highly in the character trait “conscientiousness” will tend to live longer. The impact is so great, that a child’s scores will tend to dictate who dies in their 60s or their 80s, for example.
What does conscientiousness mean? It’s a broad character trait that’s scored in psychometric tests, so it can be things that have a direct impact on health, such as brushing one’s teeth, or things that are merely correlated, such as checking one’s work for typos (this writer does her best!).
In short, if you are the sort of person who attends to the paperwork for your taxes on time, you are probably also the sort of person who remembers to get your flu vaccination and cancer screening.
Healthy practices
This means “the usual things”, such as:
- Healthy diet (Mediterranean Diet consistently scores up top)
- Good exercise (especially the tendency to keep moving in general)
- Good sleep (7–9 hours, no compromises)
- Not drinking (or at least only very moderate consumption, but the only safe amount is zero)
- Not smoking (just don’t; there is no wiggle room on this one)
Want to learn more?
You can check out his book, which we reviewed all so recently, and you can also enjoy this video, in which he talks about matters concerning healthy aging from a neuroscientist’s perspective, ranging from heart health and neurodegeneration, to the myth of failing memory, to music and lifespan and more:
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Hello Sleep – by Dr. Jade Wu
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We’ve reviewed other sleep books before, so what makes this one stand out?
Mostly, it’s because this one takes quite a different approach.
While still giving a nod to the sensible advice you’ve already read in many places (including here at 10almonds), Dr. Wu looks to help the reader avoid falling into the trap (or: help the reader get out of the trap, if already there) of focussing so much on getting better sleep that it becomes an all-consuming stressor that takes up much of the day thinking about it, and guess what, much of the night too, because you’re busy working out how sleep-deprived you’re going to be tomorrow.
Instead, Dr. Wu recommends to work with your body rather than against it, worry less, and ultimately sleep better. Of course, the “how” of this is what makes most of the book.
She does also give chapters on things that may be different for you, based on such things as hormones, age, or medical conditions.
The writing style is pop-science but with frequent references to scientific papers as appropriate, making good science very accessible.
Bottom line: if you’ve tried everything else and/but good sleep still eludes you, this book will help you to end the battle and make friends with your sleep (a metaphor the author uses throughout the book, by the way).
Click here to check out Hello Sleep, and indeed get better sleep!
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Will there soon be a cure for HIV?
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Human immunodeficiency virus, or HIV, is a chronic health condition that can be fatal without treatment. People with HIV can live healthy lives by taking antiretroviral therapy (ART), but this medication must be taken daily in order to work, and treatment can be costly. Fortunately, researchers believe a cure is possible.
In July, a seventh person was reportedly cured of HIV following a 2015 stem cell transplant for acute myeloid leukemia. The patient stopped taking ART in 2018 and has remained in remission from HIV.
Read on to learn more about HIV, the promise of stem cell transplants, and what other potential cures are on the horizon.
What is HIV?
HIV infects and destroys the immune system’s cells, making people more susceptible to infections. If left untreated, HIV will severely impair the immune system and progress to acquired immunodeficiency syndrome (AIDS). People living with untreated AIDS typically die within three years.
People with HIV can take ART to help their immune systems recover and to reduce their viral load to an undetectable level, which slows the progression of the disease and prevents them passing the virus to others.
How can stem cell transplants cure HIV?
Several people have been cured of HIV after receiving stem cell transplants to treat leukemia or lymphoma. Stem cells are produced by the spongy tissue located in the center of some bones, and they can turn into new blood cells.
A mutation on the CCR5 gene prevents HIV from infecting new cells and creates resistance to the virus, which is why some HIV-positive people have received stem cells from donors carrying this mutation. (One person was reportedly cured of HIV after receiving stem cells without the CCR5 mutation, but further research is needed to understand how this occurred.)
Despite this promising news, experts warn that stem cell transplants can be fatal, so it’s unlikely this treatment will be available to treat people with HIV unless a stem cell transplant is needed to treat cancer. People with HIV are at an increased risk for blood cancers, such as Hodgkin lymphoma and non-Hodgkin lymphoma, which stem cell transplants can treat.
Additionally, finding compatible donors with the CCR5 mutation who share genetic heritage with patients of color can be challenging, as donors with the mutation are typically white.
What are other potential cures for HIV?
In some rare cases, people who started ART shortly after infection and later stopped treatment have maintained undetectable levels of HIV in their bodies. There have also been some people whose bodies have been able to maintain low viral loads without any ART at all.
Researchers are studying these cases in their search for a cure.
Other treatment options researchers are exploring include:
- Gene therapy: In addition to stem cell transplants, gene therapy for HIV involves removing genes from HIV particles in patients’ bodies to prevent the virus from infecting other cells.
- Immunotherapy: This treatment is typically used in cancer patients to teach their immune systems how to fight off cancer. Research has shown that giving some HIV patients antibodies that target the virus helps them reach undetectable levels of HIV without ART.
- mRNA technology: mRNA, a type of genetic material that helps produce proteins, has been used in vaccines to teach cells how to fight off viruses. Researchers are seeking a way to send mRNA to immune system cells that contain HIV.
When will there be a cure for HIV?
The United Nations and several countries have pledged to end HIV and AIDS by 2030, and a 2023 UNAIDS report affirmed that reaching this goal is possible. However, strategies to meet this goal include HIV prevention and improving access to existing treatment alongside the search for a cure, so we still don’t know when a cure might be available.
How can I find out if I have HIV?
You can get tested for HIV from your primary care provider or at your local health center. You can also purchase an at-home HIV test from a drugstore or online. If your at-home test result is positive, follow up with your health care provider to confirm the diagnosis and get treatment.
For more information, talk to your health care provider.
This article first appeared on Public Good News and is republished here under a Creative Commons license.
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The Comfort Zone – by Kristen Butler
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Are you sitting comfortably? Then we’ll begin. Funny, how being comfortable can be a good starting point, then we are advised “You have to get out of your comfort zone”.
And yet, when we think of our personal greatest moments in life, they were rarely uncomfortable moments. Why is that?
Kristen Butler wants us to resolve this paradox, with a reframe:
The comfort zone? That’s actually the “flow” zone.
Just as “slow and steady wins the race”, we can—like the proverbial tortoise—take our comfort with us as we go.
The discomfort zone? That’s the stress zone, the survival zone, the “putting out fires” zone. From the outside, it looks like we’re making a Herculean effort, and perhaps we are, but is it actually so much better than peaceful consistent productivity?
Butler writes in a way that will be relatable for many, and may be a welcome life-ring if you feel like you’ve been playing catch-up for a while.
Is she advocating for complacency, then? No, and she discusses this too. That “complacency zone” is really the “burnout zone” after being in the “survival zone” for too long.
She lays out for us, therefore, a guide for growing in comfort, expanding the comfort zone yes, but by securely pushing it from the inside, not by making a mad dash out and hoping it follows us.
Bottom line: if you’ve been (perhaps quietly) uncomfortable for a little too long for comfort, this book can reframe your approach to get you to a position of sustainable, stress-free growth.
Click here to check out The Comfort Zone, and start building yours!
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