ARTICLE SUMMARY:
Low back pain, one of the most prevalent chronic conditions, is in the early stages of moving toward a more stratified, personalized model of care. Large spine companies remain focused on their core, one-size-fits-all businesses, while advances in scientific understanding of pain and technology are creating opportunities for new entrants like Aclarion, Persica Pharma, and Boston Scientific. A first of its kind, the NIH Heal Initiative has laid the groundwork, even as it weathers funding cuts
For decades, chronic low back pain (cLBP) has been worked up with blunt tools not tied to specific diagnoses—routine MRI, crude imaging biomarkers like Modic changes and disc height loss—and, in increasingly rare cases, invasive discography that many surgeons now shun—leaving clinicians guessing which patients, if any, will benefit from surgery, nerve ablation, or drugs. Incomplete information has resulted in subpar treatment of patients who are disappointed with their results and continue to experience sometimes disabling pain. cLBP has been cited as one of the underlying causes of the opioid epidemic in the US (see Figure 1).
A wave of innovative technologies and expanding data sets is changing this equation and has the potential to upend patient care. Relievant, now part of Boston Scientific, is building a successful basivertebral nerve ablation (BVNA) business for patients whose diagnosis via MRI correlates with very specific vertebral endplate and adjacent bone marrow changes, known as Modic 1 and 2 types.
Persica Pharmaceuticals is testing an intradiscal antibiotic hydrogel therapy aimed at a subset of cLBP patients who present with discogenic pain related to an infection inside the disc. Aclarion’s Nociscan clinical decision-support platform combines magnetic resonance spectroscopy (MRS) and proprietary biomarkers to create a noninvasive “virtual discogram.” Further downstream, the National Institutes of Health (NIH) BACPAC/HEAL Initiative, the largest federally funded effort of its kind, has spent eight years collecting the most comprehensive dataset ever assembled from patients with cLBP and is now using that data to conduct basic research on its biological, physiological, and behavioral causes.
