Minimally Invasive Spine and Pain Interventions (MIPSI) are poised to revolutionize the healthcare industry. The need for specialized fields emerges as disease burdens grow, and pain medicine is a new medical paradigm requiring specialists trained to address the unique needs of patients with chronic and complex pain. Pain medicine focuses on managing subacute, chronic, intractable, and resistant painful conditions primarily through Minimally Invasive Spine and Pain Interventions. While acute pain is typically managed by specialists in relevant fields and perioperative pain mainly by Anesthesiologists, pain medicine addresses the chronic spectrum.
Interventional techniques encompass minimally invasive, non-surgical procedures like percutaneous precision needle placement for targeted drug delivery or nerve ablation. Some surgical techniques are also used for diagnosing and managing chronic, persistent, or intractable pain, including laser or endoscopic discectomy, vertebroplasty, intrathecal infusion pumps, and spinal cord stimulators.
Significant evidence links chronic pain to substantial economic, societal, and health outcomes. The increasing geriatric population and the concerning rise in chronic pain among younger individuals underscore the need for this specialty. A study across 42 countries found that self-reported chronic pain was prevalent among adolescents, with 20.6% experiencing pain in at least two sites, such as headaches, stomachaches, and backaches. Chronic pain affects up to 30% of individuals aged 18–39 years.
A survey conducted by the Indian Society for the Study of Pain revealed that 43% of patients with chronic pain who consult pain physicians fall within the young age group of 25-45 years. Additionally, the substantial costs and disability associated with decreased functioning, along with the overuse of opioids and related fatalities, have been well documented. Severe and chronic pain can impair mobility and function, diminish overall quality of life, and hinder human flourishing and productivity.
Prevalence of Chronic Pain Worldwide
According to a study published by the National Centre for Biotechnology Information (NCBI) in 2015, approximately 19.6% of individuals aged 20 to 60 years suffer from low back pain globally. A study by the Centers for Disease Control and Prevention (CDC) in 2012 indicated that around 20.3% of the U.S. population suffers from lower back pain. As reported by the American Academy of Pain Medicine (AAPM) in 2012, over 100 million people in the U.S. suffer from chronic pain annually, compared to 25.8 million from diabetes, 16.3 million from coronary heart disease, and 11.9 million from cancer. This number is expected to rise in the near future. Furthermore, 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, about one-third to half of the U.K. population suffers from chronic pain.
Prevalence of Chronic Pain in India and Its Impact
The prevalence of chronic pain (CP) is well-documented in Europe, America, and Australia. Approximately 30% of the global population experiences pain. Various regional pain surveys provide reliable estimates indicating that the prevalence of CP is approximately 30%–40%. A study published in the Indian Journal of Palliative Care highlights a significant chronic pain burden in India, with a prevalence rate of 19.3%, translating to 180–200 million adults suffering from CP. Thirty-six percent of respondents were unable to perform their routine tasks due to pain, 25.5% had accepted pain as a part of their lives, and 14.1% experienced anxiety and depression due to CP. Given that populations in low- and middle-income countries largely depend on government healthcare systems for affordable treatment, this prevalence study underscores the need for government and administrative agencies to allocate proper budgets and organize management plans for pain management at various healthcare levels.
Musculoskeletal disorders, pain related to surgeries and injuries, and spine problems constitute the largest global burden of pain, with low back pain being the leading cause of years lived with disability worldwide, hindering physical activities. The World Health Organization estimates that 80% of patients with severe pain never receive adequate treatment. Additionally, the World Health Organization predicts that by 2030, chronic pain will be a significant co-morbidity among the four leading causes of the global burden of disease.
Unmanaged pain also has a significant economic impact and vice versa, affecting both individuals and society. A European study found that 61% of chronic pain sufferers were less able or unable to work outside the home, and 19% lost their jobs due to pain.
Cost Effectiveness of Minimally Invasive Interventions for Sub-Acute and Chronic Pain
Based on clinical experience, we hypothesize that minimal interventional procedures will be more effective for patients with chronic pain than a program without these procedures. The primary benefit is not just pain reduction but also improved functioning and quality of life. The costs of minimal interventional procedures are about half to one-third of those for surgical procedures. We acknowledge that the average costs for patients undergoing minimal interventional procedures are higher than for those managed conservatively. However, if clinical outcomes are better, these procedures are cost-effective if the incremental costs are justified. Furthermore, improved clinical outcomes and quicker recovery lead to reduced additional healthcare consumption, lower work absenteeism costs, and consequently lower overall additional costs. This is particularly crucial for the younger population.
Future
The increasing prevalence of chronic pain is expected to boost the demand for interventional pain management techniques, driving growth in the interventional pain management market in the near future. Most market surveys predict significant growth in the field of Interventional Pain Management and an increasing demand for these techniques over the next five years (2018-2023). Indian doctors have already demonstrated their capability in managing chronic pain patients, and patients from this region have great confidence in Indian doctors and pain physicians due to their ethical practices and expertise. Given this background, India is well-positioned to lead in medical tourism, attracting patients with chronic pain from this part of the world.
Disclaimer: The information provided in this blog post is for general informational purposes only and should not be considered professional advice. Before making any health-related decisions, consult with a qualified healthcare professional. The content is not a substitute for medical advice, and individual results may vary. The author and website are not responsible for any consequences arising from the use of the information provided. Use your best judgment and seek professional advice when needed.
FAQ-
Q. Is minimally invasive spine surgery a viable treatment option for degenerative lumbar pathology?
ANS. The advent of minimally invasive spine surgery (MISS) has further broadened the range of treatment options for the treatment of degenerative lumbar pathology [ ]. MISS remains a relatively new concept which expectedly leads to queries regarding its risks and benefits.
