Move Over Opioids, Neuromodulation Is What’s Next.

January 28, 2020

Cleveland has long been at the forefront of an industry gaining new traction as an effective and drug-free pain remedy: neuromodulation.

Neuromodulation is described by the North American Neuromodulation Society (NANS) as “a number of treatment modalities” used to resolve pain as well as symptoms of nervous system disorders — such as Parkinson’s disease, chronic migraines, seizures, paralysis, overactive bladders, obsessive-compulsive disorder and more — “typically utilizing implantable techniques.” Neurostimulation is a form of neuromodulation, utilizing various frequencies generated by devices such as programmable generators and electrodes/leads. When activated, these devices disrupt or block painful nerve signals, offering patients relief.

Jon J. Snyder, entrepreneur-in-residence at BioEnterprise and founder and former CEO of Neuros Medical, explains. “The technology being developed by Neuros blocks a nerve using a high-frequency electrical signal, similar to the way lidocaine works chemically,” he says.

Neuros Medical was founded in 2008 and has raised nearly $40 million in its mission to treat chronic pain using its proprietary Electrical Nerve Block device. Yet it’s is just one of a handful of Cleveland companies leading the market within this relatively narrow field; In 2011, Boston Scientific acquired Cleveland Clinic neuromodulation spinoff Intelect Medical for $78 million. In the last year alone, SPR Therapeutics announced a promising study on sustained pain relief, newcomer Neuronoff was awarded a $2.2 million National Institutes of Health grant, and Checkpoint Surgical received FDA Breakthrough Device designation and is doubling its workforce.

Why all the Cleveland love? Neuromodulation is in our family tree, as Snyder puts it. As a modern therapy, neuromodulation (and its sibling, Functional Electrical Stimulation) was pioneered in Cleveland at the Western Reserve Medical School (now Case Western Reserve University) in the 1960s. Today’s leaders in the industry tend to be educated by the students of the sector’s originators, and there’s been a lot of historical investment in research and infrastructure. Thus, from the research of C. Norman Shealy, J. Thomas Mortimer, Patrick Crago, Hunter Peckham, Ron Triolo and many others, neurostimulation is expected to achieve a market value of more than $15 billion by 2027.

Though young as a modern medical practice — spinal cord stimulation was invented in 1967 and commercialized in the late 1980s — today there exists a range of neuromodulation applications, all of which consist of a particular nerve, nerve bundle or anatomical region. The following are a few of the most common targets for neuromodulation:

  • Deep brain: treats disorders like Parkinson’s Disease and tremors
  • Spinal cord: used in pain management, particularly for intractable pain of the trunk and limbs
  • Vagus nerve: helps control epilepsy and mood disorders such as depression, as well as digestive, respiratory and reflex actions like swallowing and vomiting
  • Motor cortex: one of the principal brain areas involved in motor function and the execution of movement
  • Peripheral nerve: controls the functions of sensation, movement and motor coordination across the entire body
  • Cerebellum cortex: coordinates voluntary movements like balance, speech and posture
  • Cochlear: carries auditory sensory signals, such as hearing devices

Snyder acknowledges this therapy has experienced rapid growth and innovation. “I recall my first NANS conference in 2008, when a keynote presentation focused on the ‘autopsy’ of a failed randomized controlled trial applying neurostimulation for stroke,” he recounts. “Having just returned from the 2020 NANS conference, it’s fulfilling to see the variety of neuromodulation therapies on the market since then, in a wide range of therapeutic applications, with more to come.”

But while the opioid epidemic offers one perspective on this sector’s current strength, Charles Steiner, technology development director at Cleveland Clinic Innovations, believes the region’s activity today can’t be wholly attributed to this need.

“In my opinion there is a little bit of a hammer-nail situation. There is funding/support [in Cleveland]. Our region is strong, one of the strongest in neuromodulation.”

Read more about a few of BioEnterprise’s portfolio companies using neurostimulation to address short-term and chronic pain:

  • Checkpoint Surgical
    • A spinout company from NDI Medical, Checkpoint Surgical has developed an FDA-approved single-use nerve location and protection device for intraoperative use by surgeons. The product is useful in over 2 million orthopedic, ENT, neurological and plastic surgeries. Checkpoint is designed to provide safer and more accurate and reliable performance than current methods.
  • Neuronoff
    • A medical device company focused on the development of the Injectrode, a novel injectable metal electrode which is deployed via a small needle for manufacturing the neuromodulation interface inside the body on a variety of anatomical targets.
  • Neuros Medical
    • Developing neurostimulation therapies for unmet needs to patients worldwide. The company’s patented platform technology, Electrical Nerve Block, is focused on elimination of chronic pain in a variety of applications including neuroma/residual limb pain, chronic post-surgical pain and chronic migraine.
  • SPR Therapeutics
    • A spinoff of NDI Medical, SPR has developed a proprietary peripheral nerve stimulation platform to address a critical unmet need for nonnarcotic, less-invasive, reversible and cost-effective treatments for acute, post-operative and chronic pain.

BioEnterprise EIR Resources:

Karen Spilizewski
Jon J. Snyder

Northeast Ohio Resources:

Neural Engineering Center at Case Western Reserve University
McIntyre Lab at Case Western Reserve University
VA APT Center
Cleveland FES Center
UH Neurological Institute’s Functional and Restorative Neurosurgery Center