THE LAST WORD
I expect readers will tire of hearing this from me in due time, but the opioid addiction crisis has, ironically, become
a rather painful burden on the healthcare
system. The scary reality of this crisis is that
it’s not junkies abusing the system causing
the issues—it’s chronic pain sufferers believing opioids are the only reliable option
to manage their pain. Because of this, informing the public at large about technological alternatives to opioids has become
my small contribution to battling this crisis.
Thankfully, there are other more influential people than myself attempting
to educate the masses. I recently had the
chance to speak with Amy Baxter, M.D.,
pediatric emergency physician, pain researcher, and CEO and founder of MMJ
Labs. If her company doesn’t sound immediately familiar, her flagship product
might: “Buzzy,” a bee-shaped Class I U.S.
Food and Drug Administration-cleared
device designed to use cold and vibration
to prevent injection pain, was featured on
ABC’s“Shark Tank” in 2014.
While Buzzy has undoubtedly been useful for the needle-fearing public, I was more
interested in a wearable device recently
launched during the runDisney Health and
Fitness Expo in Orlando, Fla., with a variety
of orthopedic applications called VibraCool,
a wearable technology pairing a palm-sized
vibrating unit with specially designed ice
packs that freeze and attach securely to the
device. The device is strapped to the affected
area and applies cold and high-frequency
vibration for an amount of time determined
by the type of ailment.
VibraCool operates on the “gate control pain relief” method. In short, the device’s cold and vibration “confuse” the
body’s nerves to distract from the pain. Dr.
Baxter told me the nerves sensing tem-
perature and vibration combine to send a
pain message to the brain, and her tech-
nology’s hyperstimulating cold and vi-
bration “shuts the gate” on each of these
processes, blocking pain. According to Dr.
Baxter, VibraCool can be used for physical
therapy, injuries, arthritis, training recov-
ery, and plantar fasciitis treatment—some
of which have historically been managed
with painkillers. It sounds like such a sim-
ple solution to managing pain that one
has to wonder why technologies like these
haven’t hit the healthcare mainstream.
According to Dr. Baxter, the problems
of adopting pain management technologies like VibraCool are manifold, and hinge
on an archaic and impractical approach to
pain management. She told me that physicians’ goals of “pain-free” is impractical
because it only amplifies the fear of pain—
which, in turn, causes more pain. It makes
sense; if a physician tells a patient not to
expect any pain and it occurs, the patient
assumes something has gone very wrong
and will request a stronger dose.
She also explained that a physical
problem like orthopedic pain often necessitates a physical solution, rather than a
pharmacological one. That’s why devices
that cool and vibrate often provide more
effective relief than opioids in the short-term, creating what Dr. Baxter called a
“logical physiological solution.” However,
she also said that mechanical pain relief
(i.e., vibration) often sounds like pseudo-science. Many researchers and clinicians
have a bias against it, despite that vibration has been demonstrated to speed
healing in cases like orthodontics, where
it enhances the bone’s remodeling. Orthopedists, she said, would do well to think
back to their histology classes—it makes
sense that motion can decrease pain. This
skepticism is part of the reason why, as Dr.
Baxter explained, patients unfortunately
aren’t offered alternatives to painkillers as
often as they should be.
Dr. Baxter further emphasized that of-
fering patients pain management options
with scalable, realistic goals is a good initial
step to changing the management strat-
egy. The goal should not be“pain free,” but
rather controlled to a degree the patient is
comfortable with. The key, she explained,
is to offer options that empower patients
to take care of their pain from the begin-
ning. Rather than the “one-size-fits-all”
approach of opioids, patients should be
made aware that there are options that al-
low them—rather than a prescription—to
control their pain relief.
In a healthcare environment purporting to offer more personalized solutions,
pain management strategy appears to be
lagging behind. Perhaps the most important sentiment Dr. Baxter relayed to me
was this: Since pain is often subjective, its
management will also vary from patient
to patient. She suggested that patients
should be offered a pain management
“menu” when initially discussing their
options with a physician to determine
the most palatable flavor of treatment.
Patients fear pain because they consider
it as something beyond their control. Unfortunately, opioids eventually exacerbate
this issue because taking them around the
clock to alleviate pain is yet another force
beyond patient control.
Of course, even if the public is educated about patient-controlled external neuromodulation (i.e., devices like VibraCool),
making them affordable is a pain in itself.
The Centers for Medicare & Medicaid
Services (CMS) needs to invest in different sets of pain management technologies
in the best interest of the patient, Dr. Baxter implored, but there’s not a fast track
for these to be cleared. Methods that do
an equivalent job to an existing device (or
drug), but more inexpensive, can be difficult to get through CMS because the system isn’t set up to find cheaper solutions.
Ideally, she said, patients would receive a
number of trial units, and the one that actually works receives reimbursement. That
way, patients might try on a number of devices at home to determine their best fit. v
Debunking the Skepticism of the ‘Good Vibes’ Treatment
Sam Brusco • Associate Editor