As medicine becomes more digital, pain care becomes more tailored

As some of my colleagues have opined before, a new era of managing pain is here. While we may still be in the early phases of this shift, in the last 10 years, we’ve moved away from a script writing one-size-fits-all approach to all types of pain and toward a much more nuanced, patient-centric approach.

And as someone who’s been developing medical devices for 20-plus years, I’m inspired and energized by the advances that are happening across med-tech. It is wonderful to see medical devices are gaining prominence in the treatment pathways, securing more broad coverage, and becoming an integral part of pain management therapies. Certainly, the role of effective non-opioid medicines, which Pacira has pioneered, is still very prominent and will always be on the front line for managing pain. But just as each patient’s pain is varied and multifaceted, approaches to treat it must be, too. Which is why the goal in pain care is to broaden our armamentarium of technologies according to what the science – and patients – tell us is needed.

Like nearly every area of our lives, medical devices are becoming more advanced and digitized, through platforms like robotics, AI, virtual reality, augmented reality, and more. At Pacira, we are looking broadly at the medical technology space to find better solutions for these patients. Interestingly, by integrating devices as part of our portfolio, it gives us some important advantages, one of which is that the development cycle is much shorter than drugs, so you can go from concept to launch in two or three years and then quickly iterate to version 2.0 the next year. With the expansion of consumer electronics, devices have been able to leverage these gains. Particularly in pain management, they have become more user-friendly, more portable, and more targeted towards a seamless physician and patient experience, endowing them with exciting potential for both acute and chronic pain.

My team’s area of focus has been using advanced cryotherapy to freeze and silence the pain-conduction signals through nerves. Most people will intuitively know that cold helps reduce pain – applying ice to injuries is fairly common knowledge for most people, and scientifically it really does work. Through the power of biomedical engineering, we’ve been able to tap into this basic phenomenon and finetune it to the point where we can apply extreme cold to a single targeted nerve to stop pain in its tracks.

It’s called cryoneurolysis, and from my perspective, it’s one of the most exciting developments in pain care. No chemicals or drugs are injected into the patient. We actually use the water from the body’s own fluids to create these ice balls at exactly the right temperature and duration to stop the nerve from transmitting pain. The freezing temperature is enough to cause temporary degeneration of axon and myelin sheath, but it leaves the surrounding perineurium and epineurium intact. In also has no effect on surrounding tissue that might scar or induce muscle atrophy. The axon and myelin sheath will eventually fully regenerate from the lesion distally, which typically occurs at about 1-2 mm a day. At that point nerve signaling is restored. For many patients, this rate of regeneration means the treatment is effective for months, sometimes much longer.

While the technology and impact is fascinating – so is the fact that it fits into a handheld portal device. Cryoneurolysis used to be relegated to large hospitals with the resources to store huge gas tanks and have a specialist on staff who knew how to use it under very specific surgical conditions. Now it’s able to be used for everyday outpatient procedures, by multiple people in a doctor’s office. Our technology is typically used in two key ways – for surgical (acute) pain like prior to knee replacement surgery or for chronic pain like osteoarthritic pain of the knee. When it’s used in conjunction with a surgery, it can reduce the need for opioids, reduce pain, and shorten the length of stay in the hospital. It can also support rehab, allowing patients to recover from their surgery faster and even get back to work and the activities they love sooner.

With the changes in our society, health and life expectancy combined with opioid abuse awareness and legislation like the NOPAIN Act, pain management therapies are poised to gain even more steam in the years ahead. Most have been underutilized when compared to the scale of the problems we are facing. To facilitate this, devices and other therapies must continue to become more high-tech, as the types of pain we can address become broader and not limited to hospital or traditional clinic settings. And as they become more user-friendly and compact, the healthcare providers who administer these therapies can also expand (e.g., to physician’s assistants and nurse practitioners). Providing them in general practitioner offices and even mobile clinics can also help us meet patients where they are.

Pain management has become a massive healthcare challenge and financial burden, and as such, providers and their patients are looking for a full range of solutions, and now science is delivering. As researchers unravel even more of the intricacies of how pain works, translating the findings into creative and effective gadgets will naturally follow. As a dedicated life-long med-tech innovator, I’m excited to continue refining Pacira’s tech and advancing new technology in our pipeline as well. The industry has seen some exciting new technology gain traction and wider-spread adoption in recent years, and I’m confident that the coming years will see even more.

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