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 pain, cold, and vibration are three different nerves running alongside each other, and hyperstimulating cold and vibration let them crowd out pain, effectively "shutting the gate" and blocking pain sensations. According to Dr. Baxter, VibraCool can be used for physical therapy, injuries, arthritis, training recovery, and plantar fasciitis treatment—some of which have historically been managed with painkillers. It sounds like such a simple 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 offering patients pain management options with scalable, realistic goals is a good initial step to changing the management strategy. 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 beginning. Rather than the “one-size-fits-all” approach of opioids, patients should be made aware that there are options that allow 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.