An Australian Woman With Chronic Back Pain, A Beautiful Neurosurgeon and A 3D-Printed Spine Implant (Plus Other Patients With Custom 3D-Printed Body Parts)

Source of Featured Image:

RMIT University

https://www.rmit.edu.au/news/all-news/2015/august/australias-first-3d-printed-spine-implant/

Dear Pain Matters blog readers,

Is this the title of a new science fiction novel??

“An Australian Woman With Chronic Back Pain, A Beautiful (Neurosurgeon’s) Mind and A 3D-Printed Spine Implant”

No, this is not science fiction….This really did happen!

Welcome to the futuristic world of 3D-printed body parts, and its potential role in reducing chronic pain!

Happily, for Amanda Gorvin, the future is now!

Amanda (38) had suffered persistent and crippling lower back pain for more than 30 years.  Amanda suffered shooting pains and countless sleepless nights due to a deformed lower back vertebra.  She had spent an entire adult life on antiinflammatories, ibuprofen, Nurofen, cortisone injections and physiotherapy.  Amanda’s lower back pain had affected her quality of sleep, resulting in only 3-4 hours sleep a night, as well as lethargy and exhaustion during her waking hours.  By now, her lower back pain adversely affected her social, sporting and sex life.  She was unable to dress herself without exerting a huge and painful effort.  As a result of her lower back pain that limited her physical activity, Amanda gained 30 kg in 5 years.

She finally had enough of her ‘bones rubbing’ in her lower back, causing excruciating pain every time she moved.  One night at 2AM, she dragged herself out of bed and crawled into the kitchen, crying out in pain.  At a loss what to do next, Amanda told her neurosurgeon, Dr Marc Coughlan, several days later, “Marc, I can’t do this anymore.”

Her neurosurgeon replied, “I’ve got this new thing.”

Dr Marc Coughlan and another surgeon collaborated with 3D implant company, Anatomics, and a team of scientists and engineers at RMIT University (Melbourne) to custom design a 3D-printed spinal implant for Amanda Gorvin.  Few international surgeons have done this procedure, and Dr Marc Coughan was the first Australian surgeon to attempt this.  His patient, Amanda, was Australia’s first patient to agree to this.

After explaining the risks to Amanda, Dr Marc Coughlan operated on 3 April 2015 to insert a custom 3D-printed spinal implant into her lower back.

In Dr Coughlan’s words (quoting):

“The beautiful thing when we put the implant in was that it felt like a key going into a lock.  I could actually feel it click into place.  It was so intrinsically stable, it was like a dream for a spinal surgeon.”   

marc 201x214

Dr Marc Coughlan, MBChB, FRACS, FCS

Source:

http://www.coastalneurosurgery.com.au/AboutUs.asp

After her 3D-printed spine implant operation, Amanda stated (quoting):

“I was back at work four weeks after the operation, back in the gym after six weeks,” she says. “I was breathing better, my mind was clearer, I felt lighter. It’s incredible how much influence the spine has on the rest of the body. I remember that pre-surgical pain and now I ­haven’t got one per cent of it. It’s nothing short of miraculous.” As she speaks, Gorvin becomes emotional and reaches for a tissue. “This has absolutely changed my life,” she says.”

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Amanda Gorvin

Source:

http://www.theaustralian.com.au/news/special-features/d-printing-human-organs-it-suddenly-doesnt-seem-so-far-off/story-fnolgd60-1227482157233

Results like this simply speak for themselves….

Amanda has Dr Marc Coughlan, Neurosurgeon, to thank (for his beautiful mind).  Of course, the idea would not have materialized without the help of the 3D-printing team led by RMIT University Professor Milan Brandt and key staff at Anatomics.  The custom 3D-printed spinal implant literally erased Amanda’s lower back pain (that she had suffered for more than 3 decades).

OTHER PATIENTS WITH CUSTOM 3D-PRINTED BODY PARTS INCLUDING A TITANIUM HEEL, A PLASTIC SKULL AND A TITANIUM JAW JOINT

Len Chandler (71), recipient of a 3D-printed titanium heel:

A 71-year old former builder from Rutherglen, Victoria, Australia, Len Chandler, was facing amputation of his right leg below the knee due to rare cartilage cancer in his right heel.

Luckily, a surgically-implanted 3D-printed titanium heel (the first of its kind in the world) changed his fate for the better.

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Len Chandler (above), together with replicas of his 3D-printed heel

Source:

China Daily Asia

http://www.chinadailyasia.com/asiaweekly/2015-01/16/content_15214917.html

After surgery for his 3D-printed heel implant, he stated (quoting):

“I’ve got no irritation or pain or anything from that.  It just fits perfect, I couldn’t asked for anything better.”

A 22-year old Dutch woman, recipient of a 3D-printed near-entire plastic skull:

A Dutch woman (22) suffered from severe headaches, loss of vision and compromised motor coordination as a result of abnormal skull thickening.  Without drastic intervention, she was facing further brain function loss, ongoing severe headaches and an early death.

Her doctors surgically implanted a near-entire plastic skull, custom 3D-printed by Anatomics.  The operation was a huge success.  Three (3) months after her surgery, the woman’s severe headaches have disappeared and she fully regained her vision.

140327-science-3d-printed-skull_e8f32032da2f37a65e83ba184442e287.nbcnews-ux-600-480

Above, 3D-printed plastic skull

Source:

http://www.nbcnews.com/science/science-news/medical-first-3-d-printed-skull-successfully-implanted-woman-n65576

Richard Stratton (32), recipient of a 3D-printed titanium jaw joint:

Richard Stratton, a 32-year old Melbourne-based psychologist, received a 3D-printed prosthetic jaw implant on 23 May, 2015.

Part of his jaw had never grown properly ever since he was knocked in the jaw during childhood.  In fact, he was missing part of his jawbone including the left condyle (part of the temporomandibular joint, or TMJ).  This caused significant strain on the right side of his jaw and also left him with a crooked smile.

In recent years, he suffered sharp pain while moving his jaw, biting, chewing and eating and he also had painful headaches at night.  He was unable to fully open his mouth.

Dr George Dimitroulis (Oral and Maxillofacial Surgeon, St Vincent’s Hospital, Melbourne) designed a prosthetic jaw that included a 3D-printed titanium jaw joint implant and a 3D-printed plastic jaw joint (in collaboration with Dr Ackland and team, Department of Mechanical Engineering, The University of Melbourne).  The entire process from the initial design stage to the 5-hour operation took 3 years.

The plastic jaw TMJ is (likely) the first 3D-printed jaw joint in the world.

Quoting Dr Dimitroulis:

“The excitement was unbearable I think, just at the last minute we thought it just wasn’t going to fit in but it just slid in nicely.”

“It just clipped in.”

He has reason to be “very proud” that 3 years of hard work had resulted in such positive results.

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Above, Dr George Dimitroulis (Oral and Maxillofacial Surgeon, St Vincent Health)

Source:

https://pursuit.unimelb.edu.au/articles/the-jaws-of-life

One month after the post-surgery pain and swelling (that lasted a few days) subsided, Richard Stratton said he was able to open his mouth wider than before the surgery.  Several months later, he was chewing on both sides and eating normally.  His painful headaches at night also disappeared.

For more details, please view video by The University of Melbourne called:

‘When BioMechanics Colllides with Medicine’

Quoting Richard Stratton (several months after his operation):

“The joint has been working really, really well. It really has improved my quality of life.”

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Above, Richard Stratton’s 3D-printed titanium jaw part (attached to a 3D printed version of his skull)

images.jpeg

Above, ‘Before Surgery’ (left) and ‘After Surgery’ – with surgical scar visible on jawline (right)

Source:

http://www.abc.net.au/news/2015-06-20/melbourne-man-receives-titanium-3d-printed-prosthetic-jaw/6536788

Patients with severe TMJ pain caused by jaw joint osteoarthritis, cancer, trauma or congenital abnormalities may benefit from 3D-printed titanium jaw joint implants.  Such implants may lead to complete restoration of jaw function plus significantly reduced/nil jaw pain.

SUMMARY

Here’s to the future that may include 3D-printed body implants to help reduce chronic pain!  Happily, for some, the future is already here!

Sabina Walker

REFERENCES

(1A) The Shape of Things to Come

Richard Guilliatt; The Australian (The Weekend Magazine) (pages 10-14); August 15-16, 2015

http://www.theaustralian.com.au/news/special-features/d-printing-human-organs-it-suddenly-doesnt-seem-so-far-off/story-fnolgd60-1227482157233

(1B) Surgeons Print Out 3-D Body Implant

Richard Guilliatt; The Australian (page 3); August 15-16, 2015

http://www.theaustralian.com.au/news/health-science/surgeons-print-out-3d-body-implant-for-spinal-operation/story-e6frg8y6-1227484209363

(2) Joint Effort Produces Australia’s First 3D Printed Spine Implant

RMIT University; August 17, 2015

https://www.rmit.edu.au/news/all-news/2015/august/australias-first-3d-printed-spine-implant/

(3) Anatomics

http://www.anatomics.com/company/news/

(4A) 3D Printing: Rare Cancer Sufferer, Len Chandler, Back On His Feet After Receiving Titanium Printed Heel
Lisa Tucker; ABC News; 22 Oct 2014

http://www.abc.net.au/news/2014-10-21/rare-cancer-sufferer-receives-3d-printed-heel/5830432

(4B) Close to the Bone
Karl Wilson (in Sydney, Australia); China Daily Asia; 16 January, 2015

http://www.chinadailyasia.com/asiaweekly/2015-01/16/content_15214917.html

(4C) World First Heel Implant at St Vincent’s Private Hospital Melbourne 7 News

(5) Medical First: 3-D Printed Skull Successfully Implanted in Woman
James Eng; NBC News; 27 March 2014

http://www.nbcnews.com/science/science-news/medical-first-3-d-printed-skull-successfully-implanted-woman-n65576

 

(6A) The Jaws of Life

Val McFarlane; The University of Melbourne; 24 September 2015

https://pursuit.unimelb.edu.au/articles/the-jaws-of-life

(6B) Titanium, 3D-Printed Prosthetic Jaw Implanted in Melbourne Man in Australian First Surgery

Stephanie Ferrier; ABC News; 22 Jun 2015

http://www.abc.net.au/news/2015-06-20/melbourne-man-receives-titanium-3d-printed-prosthetic-jaw/6536788

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Ziconotide (Prialt) User Reviews – The Fine Line Between Maximizing Pain Relief and Minimizing Severe Adverse Effects

Source of Featured Image:

https://en.wikipedia.org/wiki/Conus_magus

Dear Pain Matters blog readers,

Many nerve pain sufferers say they have tried EVERYTHING, to no avail.

The good news is that some patients with severe, intractable nerve pain obtain pain relief following Ziconotide (Prialt) treatment (while, sadly, others don’t).

Ziconotide (Prialt) is synthesized based on the venom of a marine snail called Conus magus.

For further details on Ziconotide (Prialt), please refer to literature including a paper by McGivern (2007).  You are also welcome to go to my earlier blog post, here:

https://painmatters.wordpress.com/2014/11/10/ziconotide-prialt-for-nerve-pain-including-crps/

BRIEF ANALYSIS OF ‘PRIALT USER REVIEWS’

An internet site called ‘Prialt User Reviews’ offers a collection of patient reviews:

http://www.rxlist.com/script/main/rxlist_view_comments.asp?drug=prialt&questionid=fdb92576_pem

The ‘Prialt User Reviews’  show that Prialt treatment may be a ‘hit-or-miss’ treatment for many patients with severe nerve pain.  Thus, while some severe nerve pain sufferers obtained significant pain relief from Prialt (that outweighed its side effects), many others were worse off due to Prialt’s severe side effects.

SOME POSITIVE ‘PRIALT USER REVIEWS’ 

A patient with low back pain commented:

“I did not realise how much this new drug helped me until I had to come off of it for a short period of time.”

Another pain patient wrote:

“I developed a BAD reaction to this med, even though it worked great for my pain.  Now I have all kinds of allergies and having trouble finding a med that is as effective without side effects.

A pain patient with 2 spinal operations wrote:

“Since I’ve had the pump, the pain is no longer in my legs.  I will be ever thankful to that little snail and its ooze.  God bless researchers.” 

A patient with chronic pain for over 10 years had a positive experience with Prialt.  In her own words, “…since I have been on these meds, things have turned around for the good….I thank God every day that I have my life back….”

Another pain patient stated:

“This for me has been a “life changing” positive experience.  I have been on the drug well over six years with NO side effects whatsoever….This has changed my life for the better as I am now able to do volunteer work…I had my occipital nerves sectioned as well as steroid-induced osteoporosis, so totally endorse this drug for neuropathic pain.”

A cancer survivor with chronic pain stated:

“My pain was due to cancer which is now in remission.  My first pain clinic pushed me too hard to increase Prialt and side effects were bad!  I heard music and it felt like my teeth were melting!  I kept reducing my Prialt until it was mixed w/a narcotic and that combination made my pain level from a constant 9 … to a livable 5-7!  This is the lowest my pain level has been in 9 yrs! … I am finally pleased with my Prialt and my Life.  After 8 years of trying different combinations and Prialt Levels and 1 pump reposition and 1 pump replacement, I am finally able to Live.  I can meet my husband for lunch most days ….Yes, it took several years to get the level just right and the side effects lower, but it was totally worth it to finally have a more normal and happy life!”

SOME NEGATIVE ‘PRIALT USER REVIEWS’ 

A patient with CRPS (RSD) for 8 years stated that Prialt is thebest at relieving pain BUT it’s not worth the side effects I get….several bad experiences and I always stuck it out since the relief was so good.  It’s no longer worth it.  I have no life, hardly leave the house and spend most of the time talking to myself’.

A former user said This medicine did help my nerve pain (moderately) but the memory loss is horrible.  I lost 50 lbs in 6 months.  I can’t concentrate well, agitated, no motivation, have extreme anxiety……I started having a pungent perfumey-like smell constantly, which started to become an obsession…..led up to a full blown manic episode …no sleep….thoughts of not wanting to live anymore….border-line psychosis….I’ve been off this medication for over 2 weeks now but still suffer from some of these side effects…..”

A pain patient who unsuccessfully underwent a Prialt trial wrote:

“…I started an IT pump trial with Prialt…..and the med was increased slowly (started out with about 4 mcg/day.  Increased eventually to about 7 mcg/day).  With the first increase, my pain improved (decreased).  With each successive increase of Prialt, my pain increased and so did side effects.  I became extremely dizzy, nauseated (with vomiting), confused, lethargic, my vision blurred, and I was unable to do anything but lie in bed and wonder what Prialt was doing to my brain…..”

IS DOSAGE AN ISSUE?

I find it very interesting that nerve pain levels did improve in several patients following Prialt treatment, despite severe side effects (see above).

Is it possible that the intrathecally-administered (spinally-administered) dosages were simply too high for those who suffered severe side effects, post-Prialt treatment?

Would nerve pain patients benefit from lower Prialt dosages for longer periods (before deciding to increase dosages)?  

Consider this example:

A 59-year old female with severe pain due to chronic trigeminal neuralgia (TN) pain underwent a single-shot trial of intrathecal ziconotide.  To reduce any adverse effects, the ziconotide dosage was intentionally kept very low, at only 1 mcg.  The patient’s TN pain levels dropped from ‘9’ to ‘6’ (that, unfortunately, returned to her original pain levels of ‘9’, 4 hours-post-ziconotide).  As such, 1 mcg/day ziconotide was added to her intrathecal combination of morphine and clonidine.  At this low dosage, the patient reported significant relief from TN, and (importantly!) no side effects (Michiels et al, 2011).

According to Webster (2005), to minimise adverse effects while also maximising pain relief, initial dosages must be very low and titrated very slowly.  Thus, for many patients, there is a fine balance between minimal adverse effects and maximal pain relief (Webster, 2005).

Ongoing studies are warranted to ascertain why Prialt treatment offers pain relief (with minimal side effects) for some nerve pain patients, but not for others.

Many patients had to stop using Prialt due to extreme, horrific, and intolerable side effects that included severe mental impairment, psychosis, personality changes, memory loss, hallucinations, minor to severe swelling of joints, tremors, paranoia, pain, bad mood swings, problems with sleeping, hearing loud music 24/7, confusion, anxiety attacks, depression, suicide risk, severe sinus infection, slurring speech, severe neurological symptoms, vision problems, severe weight loss, burning skin/electric shock sensations and allergies.  NB It is not clear whether some of the aforementioned side effects were solely caused by Prialt and/or due to other unknown factors.  Further studies of Prialt’s side effects are warranted.

Many studies into other novel drugs are underway (more later).

Wishing all pain patients less suffering and more hope.

Sabina Walker

PS  Please read the entire Prialt Patient Information Including Side Effects sheet before deciding to use Prialt.

http://www.rxlist.com/prialt-drug/patient-images-side-effects.htm

Also (quoting):

“Patient Comments are not a substitute for professional medical advice, diagnosis, or treatment…..”

http://www.rxlist.com/script/main/rxlist_view_comments.asp?drug=prialt&questionid=fdb92576_pem

PPS  It is important to note that not all Prialt users will offer feedback (positive or otherwise).  Furthermore, human nature tends to focus on the negative, rather than on the positive.  It is possible that many who obtain pain relief from Prialt choose not to post comments, while others who suffered severe side effects due to Prialt may offer feedback (to help others).

REFERENCES

(1) McGivern; Ziconotide: a review of its pharmacology and use in the treatment of pain; Neuropsychiatr Dis Treat. 2007; 3(1): 69–85.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2654521/

(2) RxList – The Internet Drug Index

Prialt User Reviews

http://www.rxlist.com/script/main/rxlist_view_comments.asp?drug=prialt&questionid=fdb92576_pem

(3) For more information on Prialt, please refer to:

http://www.rxlist.com/prialt-drug/consumer-uses.htm

http://www.rxlist.com/prialt-drug/patient-images-side-effects.htm

http://www.prialt.com

(4) Michiels et al; Trigeminal neuralgia relief with intrathecal ziconotide; Clin J Pain 2011; 27:352-354.

http://www.researchgate.net/publication/51052321_Trigeminal_neuralgia_relief_with_intrathecal_ziconotide

(5) Webster; Ziconotide in Complex Regional Pain Syndrome (2005)

http://rsds.org/ziconotide-in-complex-regional-pain-syndrome/