Implant may slow opioid crisis

HOWLAND — In 2007, bus driver Tim Hopkins was injured by a forklift in an industrial accident. He suffered 14 fractures in the lumbar region of his spine and two fractures in his pelvis.

Hopkins, 47, of Newton Falls, was off work for nine months. He tried to return by working a desk job from October 2007 to December 2010. Sitting and even the little movement that was required turned out to be too painful.

He has been on disability ever since.

Thanks to a spinal cord stimulation implant, Hopkins now sees hope, and not only for himself.

“The reason this device is so exciting is that it could help slow the opioid crisis in our area,” Hopkins said. “It’s not prescribed and there are no side effects.”

In 2017, Dr. Maged Fouad of Mercy Health-Howland Pain Medicine, 1934 Niles Cortland Road, implanted an HF10 spinal cord stimulation system in Hopkins’ back. In an outpatient procedure, thin insulated wires are placed in the back near the spinal cord and connected to a battery pack that is implanted just under the skin near the waistline. That pack sends mild electrical pulses to calm nerves.

“This device has taken away 70 percent of the pain,” Hopkins said. “I am able to play with my grandkids at will. I can actually go to the grocery store now. I can (bend over and) look at what I’m buying. I’m more active, doing the things I want to do.

“My main goal is to go back to work. I’ve got 20 years at least left in me,” he said.

The HF10, manufactured by California-based Nevro, is billed as the next-generation spinal cord stimulation system. The nervous system is like a “closed loop” system of sensations and reactions, Fouad said. The electrical pulses interrupt the pain signals that nerve fibers are sending to the brain.

“It’s like opening a door and closing a door,” he said.

Research on pulse stimulation systems dates back to 1965 and the first implant was done in Ohio in 1967, Fouad said. He said he’s implanted more than 200 in his career, including about a half dozen of the HF10 system since it became available in the last 15 months.

Unlike previous devices, the HF10 can be left on around the clock and it doesn’t buzz the patients with vibrations when it’s working, according to the company.

One of the greatest points is that it is an alternative to painkillers, such as opioids, Fouad said. The pulse system doesn’t cloud thoughts, cause drowsiness or constipation, nor can it become addictive or fatal like pain medications can be.

“I am not a big fan of opioids,” Fouad said. “(But) I do prescribe them.”

Opioid medications produce morphine-like effects for pain relief. They also can be abused for their euphoric effects. Opioid overdose fatalities have been declared a national crisis and have hit hard locally, according to law enforcement and substance abuse officials.

Sometimes, a patient needs opioids, Fouad said. But the doctor must know how to prescribe them — and go with the lowest effective dose possible — and the patient must be monitored.

“You have to try other options first. I always encourage them to lower their medications.”

He said that’s why he’s pleased with the success of spinal cord stimulation implants for low back and leg pain, as well as for some neck and arm pain.

Even though the pain signals are reduced, patients still need to exercise cautions, such as limits on lifting.

“Don’t think you’re Superman. You’re not Superman,” he said.

Hopkins said his body can still let him know if he’s attempting something unwise.

“(The device) blocks pain. It doesn’t kill pain. I’m a diabetic. When I prick my finger, I know that. When my grandson throws his toys and it hits me, I know that.”

Hopkins said when he goes back to work, it will have to be an inside, sit-down job “because I still can’t pick up more than 15 pounds.”

Now, he said, he has hope that will happen.