A pain in your reputational rear end

By Megan Brodie 5 months ago
  • 5 months ago
Source: Netflix

9 February 2024

It’s a pain in pharma’s reputational butt that just won’t go away, and now it seems the medtech industry is also coming under fire showing that when it comes to chronic pain, any medical intervention is likely to attract negative press.

Pharma has been hammered for decades, largely due to a number of companies that marketed opioid products to patients in the early 2000s, the fallout not only continuing today with families and communities ravaged by people addicted to pain killers, but the industry also failing to recover its good reputation – if it ever had one – as court cases, Netflix shows and book releases ensure the pain never goes away.

Last year, local attention turned to a new villain in the this pain saga – medtech companies marketing spinal cord stimulators, surgical implants that send an electrical impulse to the spinal cord to block pain signals from travelling to the brain.

Researchers at the University of Sydney analysed the results of 13 clinical trials looking at data from 699 participants, comparing spinal cord stimulation treatment with placebo or no treatment for lower back pain. They concluded spinal cord stimulation was no better than placebo with little to no benefit for people with lower back pain.

In December, Painaustralia entered the fray, somewhat controversially for a peak patient organisation publishing a report with feedback from 73 people as to their experience with the stimulators. The names were provided by neurosurgeons and pain specialists and the vast majority of patients reported reducing or going off pain medication as a result of the surgery.

Painaustralia called for a national data registry on the models available and for more research and clinical trials to measure and evaluate the effectiveness of various stimulators.

With chronic pain affecting one in five Australians and about a quarter of those reporting pain as having a serious impact on their mental health or quality of their life, the unmet need for solutions is evident.

PBS data show CSL Seqirus’ chronic pain medication PALEXIA (tapentadol) made $42.3 million in PBS pre-rebate income in 2023, while generic pain medications cost the system $185 million.

The problem with all these interventions, be they medtech or medicine, is that many question the ethics of trading in pain. Sydney-based medtech Amelio Health recently completed a pilot study of people unable to return to work due to pain and found an eight week program involving a 24/7 health coach, individually tailored weekly sessions, and an AI platform that collects data from wearable devices and patient feedback also had excellent results.

Patients reported a reduction in opioid use of more than 60 per cent and a 50 per cent reduction in pain scores, anxiety, depression, fatigue and sleep disturbance. 

Because pain is “nebulous” and varies from person to person, it is difficult to pinpoint appropriate treatments. Amelio Health was founded by Kathy Hubble, a nurse with 30 years experience, including 20 in pain management – largely in major teaching and trauma hospitals.

Hubble helped establish the Australian guidelines for pain management practice and has a master’s in pain medicine from the University of Newcastle. She knows from experience the long waiting lists for outpatient care for people suffering from chronic pain.

“It would often take up to three years for an initial consult with a pain management specialist,” Hubble said, adding the ageing population is making the situation worse but that there was no long-term health data on chronic pain.

Wait times are much worse in rural and remote areas not served by pain specialists and GPs invariably treat pain with prescriptions and by referring patients for surgery or steroid injections, says Hubble.

“But either the surgery doesn’t work, the injections cease to work after some time, or the medications have side effects ranging from dependence to dangerous interactions with other medications and even suicidal ideation,” she said.

Hubble says papers published in The Lancet in 2019 from researchers in Australia, the US and Scotland found inappropriately managed post-surgery pain that became chronic was a major contributor to the global opioid epidemic.

Amelio Health has enrolled more than 100 participants to date and in October last year, Hubble travelled to the US to talk with insurers, followed by a presentation at the InsureTechConnect Conference, hosted by McKinsey.

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