Pain can be defined as a feeling of physical, emotional, or mental suffering caused by injury, illness, or other factors. It is a common medical condition and symptom that prompts individuals to seek medical attention worldwide. Pain management industry has been witnessing a remarkable upgrade. Effective pain management is crucial for improving patient outcomes and quality of life, involving the identification of the precise source of pain and the implementation of optimal treatment approaches. Healthcare professionals employ various measures to manage pain, including pharmacological interventions (such as analgesics, antidepressants, and anticonvulsants), psychological techniques (such as biofeedback and cognitive behavioral therapy), medical devices, physical therapy, exercise and the application of ice or heat to the affected area. By adopting a comprehensive approach to pain management, healthcare providers can effectively alleviate suffering and enhance the overall well-being of patients.
Classification of Pain
Based on its intensity, pain can be classified into mild, moderate and severe. In order to quantify this, medical professionals rely on a simple numerical scale, where a score of 0, implies that there is no pain, while a rating of 10 implies that the patient is suffering from excruciating pain that requires immediate medical attention. On this scale, a rating of less than 4 is recognized as mild pain, between 5 and 6 is considered as moderate level pain, and a score greater than 7 is considered to be severe pain.
Further, based on the duration of the pain, it can be categorized into the following two types:
- Acute Pain: Pain lasting for less than three to six months.
- Chronic Pain: Pain lasting for over six months or persisting beyond the course of an acute disease or post tissue healing.
The below figure highlights various classes of pain based on source / location / referral / duration.
A. Acute Pain
Acute pain is a type of pain related to soft tissue damage, such as a strained ankle or a bruise caused by a paper cut. It is a physiologic response to an adverse chemical, thermal, or mechanical stimulus, associated with surgery, trauma or acute illness. It is a consequence of the activation of pain receptors (nociceptors) at the site of tissue damage and typically lasts for less than three to six months.
Acute pain provides a warning signal of an impending medical condition to the body which requires further examination by professionals. It activates the sympathetic branch of the autonomic nervous system and stimulates various physiological responses, such as hypertension, tachycardia, diaphoresis, shallow respiration, restlessness, facial grimacing, guarding behavior, pallor and pupil dilation. It is worth noting that inadequate relief from acute pain can contribute to hypercoagulability (wherein the chance of clotting of the blood in the blood vessels is high) and impaired immunity.
B. Chronic Pain
While acute pain is a short-term sensation triggered to alert a person of a possible injury or other conditions, chronic pain persists for a longer duration. It is diagnosed as a different medical condition (as compared to acute pain) altogether, where pain signals remains active for weeks, months or even years. The International Association for the Study of Pain (IASP) defines chronic pain as a type of pain which has no biological value and persists even after the typical healing duration. Some of the most common chronic pain related physiological conditions include headache, musculoskeletal pain, cancer pain, arthritis-related pain and neuropathic pain.
Historical Overview of Pain Management Industry
The historical development within pain management industry has been a journey marked by significant milestones and advancements. From ancient times, where electric eels were used as a natural remedy for pain relief, to medieval times, where a variety of herbs (including those containing opiates) were employed for pain management, the treatment of pain have undergone a remarkable transformation. In the 15th century, the earliest form of anesthesia that includes a blend of herbs (including opium) was used to induce a state of insensitivity to pain during medical procedures. Further, in the 19th century, the pain management industry witnessed the widespread adoption of aspirin for pain relief. The 1960s marked a significant achievement with the successful implantation of a spinal cord stimulator in a patient with cancer. It is worth highlighting that in 1984, the USFDA (United States Food and Drug Administration) approved first spinal cord stimulator for the treatment of chronic pain. Moreover, in 2005, the first rechargeable stimulator (developed by Boston Scientific) was launched in the market, thereby demonstrating the beginning of innovation and advancement of pain management technologies. It is worth mentioning that the scientific fraternity worldwide is continuously working on more advanced pain management devices, focusing on optimizing efficacy and minimizing the associated risks.
Leading Pain Management Device Developers in Pain Management Industry
The pain management industry features over 30 leading companies, which claim to have the requisite capability to develop a wide range of pain management devices, including neurostimulation devices, infusion pump, radiofrequency ablation devices and virtual reality devices. Notably, majority of the leading device developers (80%) engaged in pain management industry are based in North America. Also, the market is currently dominated by the presence of small players (29%), while the rest of the market landscape is closely fragmented between mid-sized, large and very large players.
The below figure highlights the distribution of leading companies engaged in the development of pain management devices, based on location of their respective headquarters.
Leading device developers engaged in the pain management industry include Abbott, AppliedVR, AtriCure, Avanos Medical, Becton, Dickinson and Company, BioElectronics, Hexainnoheal, Litemed, Medtronic, Micrel Medical Devices, Nalu Medical, Nevro, Smileyscope, Stryker, ZetrOZ Systems, and Zynex Medical.
It is worth mentioning that most of the leading device developers (51%) in the pain management industry are engaged in the development of neurostimulation devices. Notable example of leading players that are engaged in the development of spinal cord stimulators include (in alphabetical order) Abbott, Boston Scientific, Medtronic and Nalu Medical.
Published Scientific Literature: Indicative of the Ongoing Pace of Research Related to Pain Management Devices
Over the years, there has been a gradual increase in the number of publications related to pain management devices. This can be attributed to the extensive research being carried out to evaluate the benefits of pain management devices. It is worth highlighting that the maximum number of articles (79) have been published in the year 2022. This can be attributed to the extensive R&D efforts being carried out in this field.
Future Perspective
Over the years, the pain management industry has made significant strides in developing innovative devices that have shown remarkable promise in evolving as next-generation patient-centric solutions. Moreover, stakeholders are actively integrating innovative technologies into existing pain management devices to enhance cost-effectiveness and user comfort. Apart from the conventional pain management devices that are used in medical procedures, non-pharmacological form of advancements (including VR and augmented reality) could mimic exact neurobiological mechanisms and reduce the threshold associated with pain. These pain-attenuating effects (especially through VR) are anticipated to shift the paradigm of pain relief options, and in revolutionizing the market by providing more effective, long-lasting solutions. Additionally, growing awareness of the risks associated with opioid-use is anticipated to increase the adoption of these advanced pain management devices, which will complement the pharmacological agents.
With such ongoing efforts in the pain management industry, we anticipate that pain management devices hold immense promise as powerful tools for alleviating suffering from pain and improving the lives of patients living with chronic pain.
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