Neuromodulation Solutions Target “Transitional” Pain

by Jeremy Koff, senior consulting editor

Traditionally, implantable neuromodulation therapies have been reserved for patients with chronic, refractory pain, while noninvasive solutions like transcutaneous electrical nerve stimulation have long occupied the space of acute pain management. However, new devices increasingly supported by clinical evidence are emerging targeting the critical window between acute and chronic pain—whether for post-operative pain or lower back pain—what clinicians refer to as “transitional pain.”

Temporary peripheral nerve stimulation, such as SPR’s SPRINT system, is designed for 60-day implantation. The system delivers targeted stimulation to peripheral nerves, often achieving lasting relief even after device removal. In a recent interview with NBR, Maria Bennett, CEO of SPR Therapeutics, stated, “We’re seeing strong interest in use of SPRINT for early-onset of neuropathic pain or trauma which may reduce opioid use and prevent surgeries. When nerves are still healthy and can be targeted early, SPRINT is an option.”

The potential to intervene before pain becomes chronic is reshaping how clinicians’ approach back pain, as well as post-surgical and trauma-related pain. Clinical studies support this shift, particularly for the use of temporary and percutaneous PNS for post-operative pain following orthopedic surgery, such as knee arthroplasty patients.

Newer noninvasive neuromodulation technologies are emerging to fill this void between acute and chronic pain. Devices like DuoTherm and VibraCool from Pain Care Labs deliver mechanical or vibratory stimulation coupled with heat or cold, offering opioid-sparing benefits without the complexity or potential complications with fully implantable devices. In a pilot study of ACL repair patients, VibraCool reduced opioid use by 35%—a figure currently being validated in ongoing trials at UCSF and Columbia. Auricular neuromodulation, such as Masimo’s NSS-2 Bridge, are also being used to evaluate postoperative pain.

The importance of addressing transitional pain is underscored by recent findings in pain medicine. Many cases of acute low back pain progress to chronic conditions—some studies show 40-50%—often linked to underlying muscle dysfunction and neuroplastic changes.

Despite promising data supporting the use of temporary and noninvasive neuromodulation to prevent the transition from acute to chronic pain, significant hurdles remain. Chief among them is reimbursement. “Reimbursement remains the biggest challenge to bringing these therapies into acute and transitional settings,” said Paul Su, an anesthesiologist and pain management physician at UCSF. “Use of PNS to treat acute or transitional pain is very challenging, as we have to justify the financial benefit (e.g., reduced length of stay). With pain medications being so inexpensive and often effective at managing acute and transitional pain, implementation of these devices is difficult due to the associated costs. In addition, a large portion of patients suffering acute and transitional pain are treated by primary care physicians. For non-interventional pain physicians, there’s a significant learning curve for any invasive or minimally invasive modalities compared to prescribing drugs.” For noninvasive solutions outside of TENS, increasing awareness by PCPs remains a significant challenge.

Although these devices show great promise in treating—and potentially preventing—the transition from acute to chronic pain, reimbursement remains a major barrier to widespread adoption, even if their effectiveness is confirmed in larger clinical trials. However, as clinical evidence continues to grow, these obstacles may gradually be overcome.