Hundreds of thousands of lives have been ruined or lost as a result of opioid addiction and the international medical establishment is moving away from recommending opioid use to treat chronic pain. But if we take that option off the table, there have to be other methods for the growing number of people suffering from chronic pain to manage it, writes Exsurgo Chief Executive Richard Little
In medicine, there is often a fine balance between risk and benefit. Tests may be intrusive, treatments may lead to serious side effects, and major surgeries may lead to injury or even death. Doctors weigh up those risks against the potential benefits and try to make the best decision for their patients.
Opioids and their synthetic alternatives are drugs that straddle that line. They have long played an important role in managing severe pain caused by injuries, operations, or cancer. The companies producing opioids started aggressively marketing them to doctors while playing down the risk of addiction and other side effects and they have been often over prescribed for things like back pain and arthritis. Around one third of those suffering from chronic non-cancer pain have been prescribed opioids, despite varying evidence of their effectiveness and plenty of evidence about their side effects.
Nearly 500,000 Americans have died from opioid overdoses since the late 1990s and now, some of the companies deemed responsible for the epidemic, like Purdue Pharma, the makers of OxyContin, McKinsey, the consultancy firm that offered advice on how to market the drugs, and a range of major pharmacy chains that dispensed them, are currently being held accountable in court.
So what happened in New Zealand? A study from 2017 (the most recent available) showed the rate of deaths from opioid overdoses increased by 33% from 2001 to 2012 and more than half of the opioid-related deaths (179) were unintentional overdoses. This increase, just like the US, was linked to more opioid prescriptions being handed out. And, according to a 2019 update from the Health Quality and Safety Commission, “the number of people in the community given a more potent opioid at least once in a year has gone up, from 63,000 people in 2011 to 80,000 people in 2017”.
Across the Tasman, opioid-related deaths increased by 62% between 2007 and 2016 and prescription opioids were responsible for more deaths than illicit opioids such as heroin. Regulatory changes were made in June last year that have made it much harder for doctors to prescribe opioids for chronic pain.
According to the ABC, “hundreds of people contacted Pain Australia when the new regulations came into effect, with many saying they did not know what options were available or that they could not access alternative services like pain clinics”. While tapering patients off opioids has been recommended, there are fears that removing them as an option will lead to some of the same issues experienced in US, such as patients using heroin as a replacement, or even suicide.
Around the world, major medical regulators like the National Institute of Care and Health in the UK have gone the same way and are pushing interventions like exercise, psychological treatment or physiotherapy to treat chronic pain.
In the future, we might have better, less harmful drugs to treat the estimated one in five people who experience chronic pain (for example, David Julius and Ardem Patapoutian jointly won the 2021 Nobel Prize for Biology and Physiology “for their discoveries of receptors for temperature and touch” and how that relates to pain) but, at the moment, the removal of opioids – even though they are not an effective long-term solution – has created a treatment gap.
And this is the gap we’re filling with our Axon system.
Rather than take a drug, patients use their brains. They wear a headset and undertake neurological exercises in the form of simple animated games on a tablet or smartphone that have been carefully calibrated to the patient’s brain activity. When the patient generates the desirable brain activity, they are rewarded with audio and visual feedback that keeps the game moving and the patient achieving their goals. Over time, we can help them retrain their brains to interpret nerve pain signals in a different way and create new, more positive pathways.
The electroencephalography (EEG) technology we use in Axon to read the brain activity is not new. It has been around for decades and is available in most hospitals and universities, but it’s expensive and difficult to access. What we have done is make that technology affordable and accessible – to the point where patients can treat themselves at home, with remote clinical oversight.
This is exactly what happened last year when we ran a clinical proof-of-concept trial in the UK during lockdown to test Axon with those experiencing chronic pain. And the results were very positive: 100% of the 16 participants reported a reduction in pain, and 50% achieved a clinically relevant reduction in pain of at least 30%. 94% of the participants also said their sleep, mood and overall quality of life improved and anxiety and depression levels decreased.
This wasn’t just a short-term fix, either. The improvements experienced after eight weeks of neurofeedback training with the Axon system were sustained up to 26 weeks and, from the evidence to date, there are no side effects.
We’re currently running a much bigger clinical trial in Auckland – the largest trial of its kind in the world – and we’re confident this will show similarly positive results.
Chronic pain is now considered to be one of the world’s biggest health issues. It’s estimated one in five people live with some form of it and this number is increasing, whether due to our ageing population, the stresses of youth (where it’s thought one in three UK teenagers are affected), or the effects of Long Covid.
In 2016, four of the leading six causes of disability in New Zealand were chronic pain conditions (chronic low back pain, migraine, chronic neck pain and other muscular-skeletal disorders) and it costs the country billions in terms of treatment and lost productivity.
In the US, one study from a few years ago estimated the total costs of chronic pain were greater than the annual costs of heart disease, cancer, and diabetes. And it’s impossible to put a price on the lives ruined through opioid addiction and lost to opioid overdose.
One of the people who was interviewed by the ABC about Australia’s shift away from opioids said “I’m not addicted. I am dependent.” At Exsurgo, we understand how debilitating chronic pain can be and how inescapable it can feel. We’ve heard the stories. But we firmly believe it’s possible to move away from a dependency on a potentially dangerous drug prescription and exchange it for a safe and effective technology alternative.