“Where does it hurt?” — one of the most common opening lines when seeing a doctor and it’s reflective of that fact that pain is a signal that is felt by almost* every single person (and animal) on the planet. It is vital to our survival — the presence of pain indicates that something is harmful or wrong, and that action must be taken to alleviate it. When that action is taken, usually the pain disappears in due course.

But what happens if it does not disappear with time? Or what if no action can be taken to make the pain go away? What if there wasn’t even any physical source of the pain to begin with?

Either way, this pain that originally was meant to serve as a warning indicator becomes something far more insidious — a persistent source of suffering that can be so unbearable that it can end in drug addiction or even death.

This is chronic pain.

Approximately 20% of the global population suffers from chronic pain to some degree — that’s over 1.5 billion people. It is one of the leading causes of disability and disease burden in the world.

Professor Sandro Galea at Boston University School of Public Health published a great review of the primary causes, and some of the socioeconomic factors that play into prevalence and severity in the United States, pleading for a higher priority to be placed on it by public health authorities. This likely holds true in other parts of the world as well — for example, in Indonesia, lower back pain is the #1 cause of disability nationwide, and headache is #2, beating diabetes, blindness, hearing loss, depression, COPD, and all other causes.

Why is it that chronic pain doesn’t receive more public attention despite it topping the list of disabilities? Not just in Indonesia, but also in China, Korea, Japan, and Singapore, to name a few. Part of it may be that it’s viewed as a symptom rather than a disease in its own right, and maybe another part of it is the inability to be measured objectively and consistently.

Right now the volume and pitch of ‘ouch’ isn’t too far away from the most common assessment of how much pain someone is suffering. It’s an old problem — how do you actually know someone is in pain, and how do you reliably compare that pain to someone else’s, or even to that same patient from the day before? How do you then use that subjective guidance when triaging or treating the pain? Were the procedures appropriate? Did they really work? How many tries did it take?

Another big problem is the overuse and abuse of painkillers, specifically opioids — something which over 12 million Americans are addicted to, and who knows how many more worldwide? The impact on families and societies of this drug abuse is immeasurable. Did each person truly suffer from chronic pain to begin with, and even if they did, were painkillers appropriate in either dose or regimen?

Scientists in the meanwhile have tried to develop several methodologies to measure pain based on visual and auditory cues (e.g. FLACC Behavioural Pain Assessment Scale, or NIAPAS), and questionnaires (e.g. McGill Pain Questionnaire, or MPI). The problem is that each of these methodologies take a fair bit of time to administer, and require some sort of judgement by either the patient and/or the caregiver conducting the assessment. As such, the results are variable, and the methodologies aren’t that commonly in use worldwide.

What is needed is a truly objective way to measure pain — I risk sounding like a broken record, but we cannot manage what we cannot measure, and the better we measure, the better we can manage. Ironically, this is exactly one problem that I tried to help solve nearly 20 years ago with my first medical device startup, using electroencephalography (EEG) analysis, and failed.

#8

In late 2019 we were at a Slush side event organised by the Finnish Ministry of Health, and it was literally a random water cooler discussion with another delegate, as we were both a little bored by the programme. The delegate pulled out from his jacket pocket a tiny PCB board with some sensors on it, and told us about how he wanted to measure pain through the simultaneous and continuous capture of all of the key biomarkers and responses considered relevant by the various widely accepted assessment scales for pain.

It was still quite early in development, but the premise was sound to us, and as a (substantial) bonus, this device could continuously measure nine clinically-relevant biomarkers for one week per charge, connect to the cloud, integrate with EHRs, be manufactured for a low cost, and could replace several larger and costlier pieces of equipment.

Combined with the founder’s mission to target emerging markets first (and he meant it, with his first business development trip to Pakistan), it was bound to have tremendous utility and impact in addition to the promise of addressing this large and established clinical problem of objectively measuring pain.

Fast forward 9 months and a few saunas in Oulu later, and we are proud to say that we have led an investment into Kipuwex Oy (lit. pain-away in Finnish), and we are excited to see where this journey takes us.

*A rare few have a congenital insensitivity to pain, and often die early due to not noticing traumas that require immediate medical attention

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