Expert comments

Comments on this technology were invited from clinical experts working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.

Three experts were involved in the development of this briefing. Two have used the device and all 3 were familiar with the technology.

Level of innovation

All of the experts said that Evoke is the first spinal cord stimulation device to record neurophysiological data and adjust the therapeutic stimulation in response. Two experts said the recording of physiological data would add valuable information. One expert said that other technologies have been designed to compensate for differences in stimulation because of changes in position by using sensors, but they do not use neurophysiological data.

Potential patient impact

Experts identified sustained pain relief and quality of life as the main patient benefits. One expert said the device could reduce the likelihood of long-term failure of spinal cord stimulation treatment. Another said that it might reduce the number of people who become tolerant to spinal cord stimulation treatment. Experts identified that this device might be particularly beneficial to people who have difficulty detecting or describing the tingling sensation used for subjective feedback of spinal cord stimulation devices, or people who want to continue driving or maintain a physically demanding job.

Potential system impact

Experts said that Evoke could reduce hospital follow-up visits because of improved pain management over time. One said that using Evoke could also reduce the use of pain management medication. One said that using objective neurophysiological data will reduce the reliance of clinicians on subjective feedback from patients. All experts expect Evoke to cost about the same as standard care.

General comments

Experts said there might be a learning curve related to programming the closed-loop spinal cord stimulation system. Evoke will become another option that can be considered for people with chronic pain, it is likely to replace traditional implants used in the NHS. Evoke has only been used in a small number of patients across the UK. Experts said the slow uptake may be related to the COVID-19 pandemic, but they do not consider there to be any barriers to adoption.