The Future of Neuromodulation

After being postponed by a whole year, the 2021 European chapter of the International Neuromodulation Society (e-INS) congress has just ended and I am here at the airport bar waiting for my cup of coffee – and the opening of the boarding of my flight back home – thinking about what I learned during the last week.

Well, it is never an easy task to condense half a week of talks, interactions, feedbacks and suggestions at a noisy bar and make sure to make something useful out of them – but my coffee seems to require more time than expected, so here I am.

First and foremost, neuromodulation is probably on the verge of (yet another) paradigm shift. Nothing extraordinary if one keeps into account how this 60-year-old therapy – at least in its modern application – has reinvented itself many times already. Indeed, it has evolved from being considered a worse solution than opioids to a better one, from having to only rely on paresthesia to becoming independent to it, from working as an open-loop system to adopting closed-loop algorithms and so on. From the beginning, neuromodulation has rhymed with revolution. So, it seems logical to expect another breakthrough from a therapy that has never been given for granted. Yes, but how?

As a researcher, one of my missions is to imagine what will be possible (and useful) in the future. And start planning for it today, to make it real tomorrow. While in a previous article (https://www.dhirubhai.net/pulse/wont-somebody-please-think-pain-patients-francesco-riillo-phd/) I mentioned how a shift away from the VAS/NRS scales would put the patients even more to the center of this therapy, this time I would like to focus on another aspect of patient-centricity - just a different angle.

Based on what emerged throughout the e-INS congress, both the neuromodulation companies and the fraction of the medical community involved in the research efforts now possess a vast amount of knowledge, both about therapy delivering and improvement, as a results of years of efforts. Revolution after revolution, the neuromodulation space has definitely evolved, but at the expense of becoming quite complex. I think that particularly after this year’s e-INS, it is legitimate to wonder how much of such complexity is really fathomed by the consumers of this therapy, that is patients and physicians who make use of neuromodulation devices but have not being involved in clinical research. My personal experience, including what came out during the past week, suggest me “not that much”.

Why would that be an issue? I think the level of complexity that we reached in this field has made challenging to grasp any new concept, and basically impossible to digest any new advancement to those who are not insiders. This in turn makes it complicated to the latter category to take informed choices and educated guesses. And that’s an issue, always. You can try to quickly google any of these new neuromodulation-related concepts (which I will not mention here), to sadly realize that it is quite hard to access education resources online. This is not good. While it might be counterintuitive for someone who possess hard-earned, sophisticated know-how (which might or might not involve some intellectual propriety) to make it widely accessible, I would like to point out how – for example – only two neuromodulation manufacturers appear in the first 25 results of Google Trends.

What does this imply? Simply that those who are not insiders, are not able to find you. We live in the world of the internet, where the 48% of the population (98% in the US) owns a device with which checks quite everything it comes in touch with.[1] Everything we approach nowadays, we do by heavily researching it online. So, if patients and physicians cannot educate themselves online before you step in, well, it sounds like we have a problem.

Bottom line, I strongly advocate for those who have neuromodulation knowledge to make it available to those who are looking for it at this very moment – your stakeholders of tomorrow. I believe this would not just benefit you but will also be a step further towards the patient- and physician-centricity. Which in turn will be the trigger of the next revolution in neuromodulation.

Or so I like to believe.

My coffee has finally come, thank you.

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1. Number of smartphone users from 2016 to 2021. Statista. https://www.statista.com/statistics/330695/number-of-smartphone-users-worldwide/. Accessed September 4, 2021.