Q&A: The Role of Emerging Technologies in the Future of Pain Management

According to Chris Robinson, MD, PhD, a future with no acute and chronic pain is much further down the line than optimists may expect. However, throughout his work researching new technologies for the treatment of pain, he believes there is a future where chronic is mitigated beyond what has been capable in the past.

“I think we have to understand what is pain, why it's there, and not have our hopes up that we think we can get 100% pain relief,” he told Drug Topics. “Our bodies do degenerate, and we have to understand that. My goal, and especially with these newer technologies, is to use it to mitigate pain in the present moment.”

Robinson thinks finding objective measures for pain is the first step in advancing our current technology. | image credit: Art_You / stock.adobe.com

With emerging technologies in the pain management space, as well as an immense amount of capital pouring into it, he believes finding objective measures for chronic and acute pain is the first step in advancing what we know about this subject.

Robinson, who is Director of Pain and Headache Rounds at Harvard-Massachusetts General Hospital, sat down with us to discuss the future of pain management in emerging technology, including virtual reality (VR), neuromodulation, artificial intelligence, wearable technology, and psychedelics.

Stay tuned for our full conversation with Robinson on our Over the Counter podcast channel and get a full breadth of where the industry is at regarding pain management technology, and where it’s headed going forward.

READ MORE: Q&A: Innovative Technologies Revolutionizing Pain Medicine

Drug Topics: Do you believe that these technologies have the future potential of finally alleviating issues of pain within the US, or do you think chronic pain is something that will burden the population indefinitely?

Chris Robinson: I think we will never be able to get rid of pain long term. If we're 65, 75, 85, our body is continuing deteriorating. There's a degenerative process occurring. In order for us to really stop pain, we have to regenerate our tissues, our cartilage, our joints, our muscle. It's hard to maintain muscle as you get older. Until we're at that point, it may be quite difficult because we have trillions of cells in our body. To coordinate that process can be difficult. There is a hope of regenerative medicine, but we may not be at that point at the moment. Can everything that we're doing now alleviate pain? I think we can push it off until further.

Let's say, you got a virtual reality headset. You just had a total knee replacement. Your knee is hurting still. You don't want to go to physical therapy because you have no one to take you. You put on that headset. You have an avatar talking with you. You get up, you're moving around at your home. Instead of you not going through physical therapy appointment, you have your headset. Now we have changed your path. Your acute pain after your knee replacement doesn't become chronic pain. Rather than having to become a chronic pain patient at the age of 55, we've gotten you moving again and again and again, and maybe that pain returns at the age of 65. We alleviated or pushed off that chronic pain for 10 years, but then again, at 65 maybe other joints are going.

Will we be able to cure pain entirely? At the current moment, I don't think we're going to get that point. Unless [with] Neuralink, we can transfer conscience into another new body, or into the cloud—joke, but not a joke. I don't see us alleviating pain entirely. I do see us giving patients better pain relief that's targeted, personalized medicine. I can prevent that conversion to chronic pain. I can delay the degeneration of some of your joints with regenerative medicine. I think we need to come to terms with what pain is. A lot of it is psychological and we don't do such a great job, just generally, on treating that as well. There's not a sufficient number of properly trained professionals to handle that aspect. Chronic pain and mental health, they're tied. About 80% of chronic pain patients have some sort of mental health disorder, which when you treat one, the other one gets better.

I think in order for us to really, truly get the maximal impact with our current treatments is to incorporate both mental health and pain treatment. And again, how do we do that? We can use AI virtual reality to provide some mental health treatments. We can use psychedelics or new oral therapeutics that are coming out to tone down the initial acute pain. Someday, I would love to cure pain, but I think we have to understand what is pain, why it's there, and not have our hopes up that we think we can get 100% pain relief. Our bodies do degenerate, and we have to understand that. My goal, and especially with these newer technologies, is to use it to mitigate pain in the present moment.

Drug Topics: What are your short- and long-term hopes for these emerging technologies?

Chris Robinson: My short-term goals are to start clinical trials, to reopen the spigot of new drug discoveries for pain. We have Vertex that came out with suzetrigine. There's Xgene that's coming out with a potential new pain drug. Short term is to really understand what these new oral therapeutics are doing for us, [and] to provide objective measures for our current interventional treatments. Your 1 out of 10 smiley face versus the frowny face may be different for you than it is for me. I want to find ways to provide objective outcomes for a lot of our treatments, so that they're here to stay.

Long term, it's more about personalized medicine. Your perception of pain may be very different of my perception of pain. Maybe my pain tolerance is not really there. That's not to say that your pain of 8 out of 10 is any worse than my 3 out of 10. Let's say I have a higher pain tolerance. There should be and there will be, I know at some point, more objective measures of pain. Just the way, if your heart is dysfunctional and you're in atrial fibrillation, or you have a heart attack, we can now objectively measure that.

At some point we will have some sort of objective measure of pain. Whether it's going to be in a decade or 50 years or next year, these are my long-term goals. I think it's not fair for someone who's been in the field for 50 years, whose knee pain—if you transfer that knee pain to me—that would probably crush me. It's not fair to that individual to say their knee pain is 2 out of 10 versus, let's say, I live in the city and my knee pain is 10 of 10, when it's actually 2 out of 10, but I'm getting more attention. That individual who's had a tougher life doesn't want to say, ‘Oh, you know, it's excruciating.’ So long term, I want to find objective ways to advocate for patients, because it's not fair that some payers put a cut-off for pain as a way to say, ‘Hey, you know what, we're not going to approve this.’ Well, that's not fair to the patient. Subjectively, I want to find objective measures for our outcomes as well as for our patients. You may say you're 2 out of 10, but we can detect that you're in significant pain. That's not fair. So long term, offering patients personalized pain treatment as well as more objective measures to say these treatments work [and] payers should cover them.

And one thing I did not mention is that chronic pain, if you adjust for inflation, it's well over $1 trillion to the health care system. We have new drugs come out for heart disease, cancer, diabetes, but yet, chronic pain consumes more health care dollars than all those 3 together. But if you look at the number of treatments coming out for those 3, it's insignificant to what's coming out for pain. Two new approvals versus the plethora that's coming out for all those 3. Long term, we need more awareness. At some point, you and I will have chronic pain whether we see a physician or not. It would be nice [if] there's treatments out there for everybody.

READ MORE: Q&A: Why Educating Patients on Emerging Pain Technology is Key

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