Paul asks Miranda about an exciting study she’s been doing on treatment for pain relief.
Thanks for talking to us today. Could you please introduce yourself and tell us a little bit about your work?
Yeah, my name’s Miranda Olding, I’m an MS specialist nurse and I work at the Bedford MS Therapy Centre.
Right, so we’re looking at the posters that you are presenting here, or you have been presenting these days. Can you tell us a little bit about the key findings?
Yeah. Okay, so basically just to put it in context, about almost three years ago, at the MS Therapy Centre, we heard about some amazing case studies which had been done up in Yorkshire by a pain management team on people with MS. That actually won a commissioning award, called the Grünenthal Award. And we got hold of one of these machines, micro-current pain relieving device called APS therapy, and we began to use it for people who wanted to try something non-pharmaceutical to treat their pain. We’ve been keeping data for the last two and a half years and our service has actually gone now to having three machines, which are pretty much constantly in use between Monday and Friday. And what we found was that in the course of the two and a half years we had well over a hundred people who used the APS therapy, but we had 68 of those people who actually did three times a week for eight weeks, so gave it a really good trial. Of those 68 people, between them they had 103 pains. Now, over their eight-week trial where they did it three times a week, 79% of the people, so that’s 54 of the 68 people, or 79 and a half per cent, had a reduction in their pain.
So some people went from having severe pain, or having pain to going pain-free. Some people just had a reduction in their pain, and obviously there were some people for whom it didn’t help at all. So the average reduction in pain was just over three points on a scale of nought to ten for usual pain and almost five points for the worst pain. But one of the exciting things, which we want to explore more, was that there was a significant amount of people who also found that it was really really helping their fatigue. We’ve also had people who find they’re having less spasms and they’re using it to treat the spasms, particularly in their legs, and people who find that it improves the quality of their sleep. And some people who find that it’s improving their spasm and spasticity are also realising that there’s a knock-on effect on their mobility. So we’re very, very excited about this, it’s something that we would really like to try and attract some funding to get proper research going for, proper randomised control trials. But one of the exciting things for me as an MS nurse as well is that of those 68 people, 33 of them actually reduced or discontinued some of their pain relieving medication, and one of the big problems that we have is that so many of the medications that we use for pain in MS, specially neuropathic pain, have really, really difficult side effects, like sedation and weight gain. So that’s my poster, in a nutshell.
That’s really remarkable in my opinion. Could you perhaps tell us how long is such a session?
The treatment takes 40 minutes in all, and that is four back-to-back eight minute placements of the electrodes, because it’s done by, in the same way as a TENS machine, although it’s a very different electrical current, electrodes are put on the skin and then you move them to different places, and you do that four times, eight minutes each. So 32 minutes if you were fast as a flash, but we allow one hour for each person’s session so that people have a chance to clear off their stuff and say hello and sit down and everything.
Are there any side effects worth mentioning?
So in the first few days of treatment some people do experience headaches or even feel woozy or we’ve even had one person vomiting. And that’s because it enhances the communication between cells, it enhances the removal of waste products, so people are advised to drink water, if they can carry on, carry on, maybe use lower settings. We had one person who felt that it seemed to exacerbate their trigeminal neuralgia, who had to give up, and one person in whom it triggered migraine symptoms. But on the whole, it’s been very safe and the effects have been beneficial.
So what are your next plans with this treatment?
So there is a big pilot study that’s been running up in Hull, in Yorkshire, for… it’s… I can’t remember the name, but they provide the pain management service for the NHS, and they should be reporting soon. And we have a neuro-rehab consultant in Northampton General Hospital who’s expressed an interest in doing a randomised control trial. And I would, as I said, I just really would like to get some proper research going, because myself and my colleague, Emma Matthews, who’s the other MS nurse who does a day at the MS Therapy Centre, we’re clinicians and not researchers and we want to just carry on doing what we’re doing. [laughs]