As part of our Spotlight on neuromodulation, we spoke to Timothy Deer, Clinical Professor of Anesthesiology at West Virginia University (VW, USA) and President of the International Neuromodulation Society (INS). Dr Deer has already led an accomplished career, and speaks in this interview about his highlights, most memorable patient cases, and looks ahead at future challenges and trends in the field of neuromodulation.
Please could you tell us a little about your background and current roles?
I am a native of West Virginia. I attended medical school at The West Virginia University School of Medicine (WV, USA) and then did training at the University of Virginia (VA, USA) in Anesthesiology and Pain Medicine. I am now the President of the International Neuromodulation Society, a society focused on research, development and advancement of the use of implantable devices to modify the nervous system and disease states. I am past President of the Committee on Pain Medicine of the American Society of Anesthesiologists, and current president of the West Virginia Society of Interventional Pain Physicians. I am Clinical Professor of Anesthesiology at West Virginia University.
Much of your research has focused on dorsal root ganglion stimulation – could you tell us some more about this? What are the major uses of this technique?
I have been involved in the research of stimulation of the dorsal root ganglion since the beginning of the technique about a decade ago. The research advanced from a single human proof-of-concept, to an open-label, multicenter acute study, to a multicenter prospective study. In 2017, we published the results of the US Pivotal Multicenter Prospective Randomized Study, which showed dorsal root ganglion stimulation to be superior to conventional stimulation. The major uses are for nerve pain in specific areas such as after surgery, trauma or systemic nerve injury, for example neuropathic pain of the feet or hands. The uses are different based on the country of use, and the therapy is used worldwide.
Do you think there will be a day when neuromodulation will be the standard in chronic pain treatment? What hurdles would need to be overcome in order to achieve this?
Neuromodulation is becoming the standard of care in many areas. Examples include sacral nerve stimulation for incontinence, deep brain stimulation for Parkinson’s disease with tremor, dorsal root ganglion stimulation for complex regional pain syndrome, and spinal cord stimulation for failed back surgery syndrome. The opioid epidemic will be important in making neuromodulation a critical part of the algorithm to avoid high dose oral opioids.
Your career has certainly been accomplished so far – including developing new treatments, research, acting on a number of boards and societies, as well as more recently being elected as President of the INS (congratulations!) – what would you say has been your career highlight so far?
The highlight of my career so far has been my role in the advancement of the spread of access to neuromodulation around the world. Increasing access to new countries and patients who suffer are the goals of the INS. The other great joy is the mentoring of young physicians and watching these young men and women advance their careers and improve our field.
What has been your most memorable patient case?
I have two: the first implantable pump I placed was in a very nice lady with severe pain from bone metastasis. Within a matter of days we had her very comfortable and she had almost a year of quality time with her family. The second case was a young soldier who was injured in a sky diving accident and was severely debilitated, wheel chair bound and on high-dose opioids. Within 2 years of implant the patient was back to a normal life, flying helicopters and a father of a new baby. He became an ambassador for injured soldiers.
As President of the INS, what do you see as the most exciting developments in the field at the moment?
New work is being done in smarter devices that can evaluate the body response to the delivered electrical current and make real time changes. Other new work is being done on the brain to find new targets to treat disease such as obesity, depression, traumatic brain injury and psychiatric disorders.
To what extent have we exploited neuromodulation techniques, particularly for the treatment of pain? How much further is there to go?
We need to continue to educate the public, payers and referring doctors regarding the value of these new modern advances. Currently only a small percentage of patients who are candidates for neuromodulation are receiving this care.
More generally, what do you see as the biggest questions in neuromodulation to address in the next 5–10 years?
We need to expand the use of neuromodulation to new disease states and to replace many pharmaceutical options that are not optimal.
You can find more interviews, opinions and journal articles on neuromodulation on our Spotlight page here