The balm of business innovation confronts the voracious 'epidemic' of pain

A squadron of new technologies has been launched to provide relief from one of the evils of our time: chronic pain, which is creeping forward, fueled by an aging population (more and more elderly people are living longer), a sedentary lifestyle, and poor eating habits. Solutions such as immersive virtual reality, passive sensors, and smart bracelets to monitor patients at home to identify any changes in their health, mobile apps that continuously monitor users, artificial intelligence and big data to detect pain patterns, and the latest innovations in neurostimulation (electrical impulses that reach the most remote parts of the nervous system) are some of the advances already being applied in hospitals, rehabilitation centers, physiotherapy clinics, and nursing homes to reduce chronic pain. They are not treatments, but rather a complement to traditional drugs and other therapies that can improve the quality of life of people suffering from chronic low back pain, osteoarthritis, rheumatism, or migraines , as well as fibromyalgia and osteoporosis-related problems. These are new technological tools being developed by companies and startups, sometimes emerging from research teams at hospitals and universities.

Chronic pain is considered a disease, not a symptom. It's also a complex condition because, in addition to experiencing pain, the person loses functionality, loses emotional balance, and often even affects their work situation. This can lead to anxiety, stress, depression, and more.

According to the latest pain barometer in Spain from 2022, a study by the Grünenthal Spain Foundation and the Pain Observatory of the University of Cádiz, chronic pain affects 25.9% of the adult population, representing more than 9 million people. "It's now 1% higher. All the tools we acquire to improve patients' quality of life will be welcome," says Héctor Beltrán, coordinator of the Digital Technology and Pain working group of the Spanish Pain Society (SED).

This invisible illness also has its bottom line. Another report from the Grünenthal Foundation Spain ("The Impact of Chronic Pain on Social Well-being") from this same year estimates that the economic cost of this disease in our country is equivalent to 2.5% of GDP, that 28.6% of these patients have been on sick leave in the last year, and that 32.3% have left their jobs.

It's clear that new technologies play a significant role in curbing chronic pain and its consequences. Virtual reality is emerging as one of the most promising. "It demonstrates a very powerful effect. It offers an engaging virtual environment that engages the brain while the patient is performing an activity that doesn't hurt. It's about empowering the patient because they see they've been able to perform movements they hadn't thought about. Virtual reality helps them overcome their fear of movement, reduces the use of medications, and teaches strategies for coping with pain. Other times, it's used as therapy to learn to relax," says Héctor Beltrán.

Monitoring patients at home with telerehabilitation sessions is another promising strategy. "This avoids daily travel to perform treatments and exercises that can be done at home. This improves the lives of these people," explains Beltrán.

Artificial intelligence, big data, machine learning... have also exploded in the world of pain. "Technological solutions must go hand in hand with companies and clinical research teams and universities, because there are companies that manufacture products but they are not designed for real needs. In the public sector, there are many national and European calls that incentivize public-private collaboration and generate good opportunities, although it is the company that has the resources to market the product," adds Beltrán.

Some of these companies with pain-relieving innovations already have their products on the market. Such as the virtual reality software designed by DynamicsVR, an SME based in Puerto de Santa María (Cádiz), which is already used in senior homes, hospitals, brain injury associations, and physiotherapy clinics. Its goal is to reduce neck, shoulder, and lower back pain; it is also used to treat the lower limbs and, in general, for motor impairments resulting from acquired brain injury. "Pain is a perception of the brain, a protection system against a perceived threat that may or may not be real. A broken bone is real pain, but when the pain becomes chronic, many factors come into play. What we do with virtual reality is decontextualize the brain from the environment it's used to living in. We trick it into another world it doesn't know, where the patient follows a therapy, for example, exercises for lower back pain." The patient moves freely during treatment, with less pain, and therefore reduces treatment time by up to 35%," says Carlos Guerra, founder and CEO of DynamicsVR.

Another version of this company's virtual reality focuses on relaxation during acute pain that can be caused by invasive treatments, such as punctures. "In this case, the pain is reduced by up to 60%," Guerra says.

In a clinical trial, DynamicsVR validates a virtual reality program for treating subacute strokes. "The goal is for the patient to begin this treatment and brain stimulation as soon as possible. This way, they'll have a better prognosis," Guerra believes.

The Figueras (Gerona) company Broomx Technologies 's offering is also an immersive reality platform for the physical and emotional improvement of patients with chronic pain or those undergoing long-term hospitalizations. However, in this case, virtual glasses are not used. "Many people can't use them because they feel dizzy or don't tolerate them well; it's complicated for children and the elderly," says Ignasi Capella, co-founder of Broomx.

By projecting images onto the walls and ceilings of a room, Broomx's technology is capable of creating environments "that give the sensation of being inside what you see: a landscape in space, at the bottom of the sea, or climbing a mountain. These are relaxing environments, with guided mindfulness practices, self-regulated breathing techniques that reduce the perception of pain..." Capella says. These sessions can be customized.

This company began applying its solution in pediatric hospitals and palliative care units to improve patients' emotional balance. "In pediatric hospitals, we installed the system in pre-surgery rooms to distract patients during those uncertain and anxious moments before surgery," says Capella. For example, the pediatric unit at Vall d'Hebron Hospital in Barcelona uses this technology.

It was the Olot Hospital (Gerona) that began applying Broomx's immersive reality to patients with chronic pain and those who had undergone complex surgeries. "The tool helps patients understand their pain, accept it, and learn to manage it," explains Capella. In immersive neurorehabilitation therapies, in therapeutic sessions in hospitals and mental health centers for young people with autism... The applications of immersive reality are very diverse. "It's a therapeutic distraction in nursing homes. It helps users perform physical exercises, for example, simulating hiking in the Himalayas," says Capella.

Quantic Nanotech 's electronic gloves for relieving osteoarthritis pain are devices for well-being, as José Luis de la Torre, their inventor and co-founder (along with a group of engineers), acknowledges. "There's still a long way to go before it's certified as a medical device," he believes. However, the first pilot study on its operation has concluded with very promising results. The observation was carried out on 40 patients at the Hospital de la Luz in Madrid who suffered from moderate to severe osteoarthritis. After 60 days of use, the gloves reduced pain by 50 to 60% in most patients. They also significantly improved grip strength, joint swelling, and the duration of morning stiffness. These conclusions were published in the American journal Scientific Literature.

Today, some 3,000 people have purchased these gloves, which José Luis de la Torre and his team of engineers have been working on since 2016. The patent has been granted in 30 countries (all over Europe, the US, China, Japan, and the Arab world). "It's a tool for patients to work at home. Until now, they only had anti-inflammatory painkillers, but they can't be taken for life. Electronic gloves don't replace any treatment, but rather are a complement," says De la Torre.

To use the gloves, first, an anti-inflammatory cream is applied to the hands; then, a thin cotton glove, and finally, the electronic gloves. "They emit low-frequency electrical micropulses and heat. The innovative approach is to combine these therapies with other medical therapies such as a cortisone cream," explains De la Torrre. The results: "The micropulses reduce and even eliminate the sensation of pain," he says. "And the heat improves hand mobility. The patient can perform actions they couldn't before."

The Madrid-based startup Brainguard was born with a clear scientific vocation to effectively predict migraine attacks. To this end, it has developed and trained an algorithm that interprets in real time the physiological and hemodynamic changes that occur in the body before the dreaded attacks of this type of headache. "It is one of the most debilitating pathologies and has no cure. There are drugs to stop the pain once it appears and treatments that reduce the frequency and intensity of attacks. Twelve percent of the Spanish population suffers from it, and 2% have more than 15 days of chronic migraine pain. Neurologists feel that we are too late," says Dr. Ana Gago-Veiga, head of the Headache Unit at the Hospital Universitario de la Princesa in Madrid. Together with José L. Ayala, professor of Electrical and Computer Engineering at the Complutense University of Madrid, they have been working for ten years on this advanced solution, in which the Polytechnic University of Madrid also participated.

Dr. Gago-Veiga explains the clinical development: "Migraine exhibits premonitory symptoms before an attack. Some patients feel tired, yawn, are bothered by light, and believe an attack is coming. Through hemodynamic changes in the patient, we were able to demonstrate that it was possible to predict migraine attacks. There are changes in heart rate, temperature, oxygen saturation... If we obtain this data, we can predict the onset of pain. We have demonstrated this and we have the patent."

And from there, the computer science technique comes in. "We needed to collect all that data on a wearable and design an app to gather pain characteristics and the patient's clinical data. By bringing all that information together, we generate an AI model that predicts when the pain is coming, communicates this to the user through the app, and gives them recommendations for managing the attack. The idea is to inform the patient that they're going to have a migraine within 20 minutes with a 75% probability," says José L. Ayala.

First, they developed their own device and conducted their first study. "It was a box that a group of patients at La Princesa Hospital wore around their waists and with cables attached to their chests. It allowed us to collect very valuable, high-quality data. This is how we achieved very robust predictive models," recalls José L. Ayala. But when it came to moving towards a wearable that patients could use in any setting and that would collect quality data, they couldn't find investors to undertake the project. So they founded the startup Brainguard, as a means of obtaining funding through accelerators and various innovation awards they have received. "We have continued developing the app and have obtained a wearable, a type of bracelet, that is used in outpatient medical applications but has no commercial use," explains José Ayala. All of Brainguard's advances and developments are being validated in a European project they entered two years ago and in which seven hospitals are participating. "We hope to demonstrate the scientific soundness of our project. The most important thing is that it is viable," Ayala says.

The Valencian startup Spinally works at the edge of innovation, in an unexplored area of ​​the spinal cord. Its goal is to alleviate chronic pain and thereby reduce the need for treatment with drugs such as opiates. It already has a prototype undergoing animal testing. It involves a very thin electrode (it works at 0.7 mm thick) for implantation in the intrathecal area of ​​the spinal cord. "This is the area closest to the spinal cord. Until now, stimulation was carried out from the epidural space. For this area, we are designing the next generation of electrodes with materials that require a certain elasticity, components, and arrangement of poles... The traditional electrode is no longer suitable. We develop hardware, software, and algorithms to listen and speak to the spinal cord before performing the stimulation," explains Carles García-Victoria, co-founder of Spinally and a specialist at the Hospital Intermutual de Levante and the Instituto Carratalá Quirón.

The intrathecal area of ​​the spinal cord is promising. "We can focus (electrical) stimulation and reach deep areas where there are neurons that we couldn't access until now and that are interesting for self-regulating pain," explains García-Victoria. It's neuromodulation therapy, "a way of telling the nerves not to transmit so much pain. When it comes to the spinal cord, a highway of nerves, we can reach it and apply electrical information that modulates how it transmits information to the brain and tell it that it hurts, but not as much," explains García-Victoria.

Spinally has secured its first round of funding through the Capital Cell platform. This solution for chronic back and leg pain also holds promise for patients with Parkinson's and other degenerative diseases.

These are the balms of business innovation that can help curb the silent illness of our time and the times to come: chronic pain.