The field of neuromodulation device development has witnessed several leaps of progress in the past few years. It is not long since the first ever smart implant for managing chronic back pain was tested on a patient. The early outcomes of the operation were positive and gave the green light to the developers to test their technology on a wider population of 30 patients. This trial is on-going.
This procedure was considered a milestone for the use of smart implants for neuromodulation, and rightly so because it involved the use of a closed-loop system capable of recording pain sensation and responding to it.
So is this the end of chronic pain? And is this the answer to disorders and diseases of the central neural system which have been the target of neuromodulation devices? I’m afraid the answer is not yet.
Take pain experience, for example. It is complex, and coming up with a system which can accurately and reliably gather data which correctly defines pain experience in order to respond to it is far from possible – especially since the pain threshold differs from individual to individual. To add more complexity, pain sensitivity differs depending on both the physiological and the psychological state of a patient.
It is little surprise that the system tested, successfully I must say, did not abolish pain altogether. The patient was quoted as saying the pain level had dropped “from eight out of ten before the treatment to two or three“.
So what can help a closed-loop system perform better? The answer is a bigger loop.
The future lies in bringing together more and better sensing technologies without ignoring the role of the patient who, depending on the condition, will be empowered and become part of the loop systems. Access to data and input to the loop from other stakeholders will be key, too.
This can be achieved in several ways – below are three modules which I think will accompany the smart implants of the future:
1. Wearables: Wearable sensing technology will provide and analyse, in real-time, data on a patient’s physical status. The additional data will allow the system to better detect false positive signals – for example, pain-associated ones. In the case of conditions such as Parkinson’s disease, the wearable modules will be detecting tremors etc and be used to monitor and feed back the effectiveness of the smart implant.
2. Connected smartphones: Tools like smartphone apps will allow a patient to input to data-gathering activities. In some cases – depending on the underlying condition and the patient’s wellbeing – this may even mean taking some control over the functionality of the loop. For example, the patient’s input will ‘teach’ the implant about their personal experience of pain and allow the system to better define an individual’s pain threshold.
3. Cloud: Cloud technology will allow a healthcare professional to take oversight of a patient's disease state. The healthcare professional will have access to data generated by all sources – smart implants, wearable devices and patients. Using wireless connectivity, they may be able to intervene when and where it is required.
Looking into the future and how smart implants are likely to evolve over the next few years, I believe that creating digital ecosystems is the way forward. The enabling technologies that will allow the development of such ecosystems are already available. The challenge is to identify the right condition – and the right individuals that such ecosystem will be of value to.