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European Biopharmaceutical Review

Effective Electroceuticals

Pain is a normal physiologic signal by which the brain communicates to an individual that tissues in the body are in danger or have already been damaged. Typically, when the tissue damaging agent is removed or the tissue heals, the pain subsides. However, sometimes, even long after the tissues have healed, the brain continues to sense pain – this is classified as chronic pain. More specifically, the International Association for the Study of Pain (IASP) defines pain as chronic if it lasts for more than three to six months (1). Chronic pain can manifest as musculoskeletal, neuropathic, or idiopathic, but, most importantly, it can significantly reduce quality of life due to both physical and emotional impacts on the individual. Chronic pain is remarkably prevalent, affecting up to 30% of the global population, reflecting a global therapeutic market that is expected to exceed US $83 billion by 2024, or approximately onethird the size of total current biopharmaceutical markets (2-3).

Currently, three main classes of traditional pharmacologic interventions (OTC and prescription) are used to manage pain: 1) opioids/opioid-like agents/opioid-analgesic combinations; 2) NSAID’s/analgesics; and 3) adjuvant therapies such as antidepressants, anti-convulsants, anti-rheumatics/immunologics, muscle relaxants, topical products, and corticosteroids. Biopharmaceutical approaches to pain management have not, to date, been extensively pursued. In part, this may be because biopharmacologic approaches tend to be more focussed on personalised therapies, and pain is often considered a generic healthcare challenge (4). However, recent developments in pain management suggest an opportunity for the development of targeted therapies, a strategy that may fit well with the biopharma industry’s long-term goals (5).

Central Sensitisation

The neurophysiologic understanding of pain management is founded on the work of Melzack and Wall who introduced the Gate Control Theory in the mid-1960s (6). The commonly observed phenomenon of reducing pain sensation by rubbing injured tissue was explained in this theory as the ability of fast, sensory nerve fibers serving to block the activity of the slow, noxious nerve fibres. This theory quickly led to the development of transcutaneous electrical nerve stimulation (TENS) technology as a means to block pain and therefore provide a non-pharma approach to pain management. While it is not practical to ‘rub’ injured tissue continuously, an electrical stimulator using electrode pads on the skin to permit electrical current injection can readily be designed to operate for hours, thereby providing sustained pain relief. However, sustained electrical stimuli in and of themselves can be irritating, and, furthermore, high electrical current densities injected through the electrode pads can damage skin, so usage is typically limited to a few hours per day.

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Dr Sree Koneru obtained his doctoral degree in biomedical engineering from the State University of New York at Binghamton, US. His research expertise is in investigating physiological responses of pulsed radiofrequency EMF for the development of advanced electroceutical devices. Sree leads new product development at BioElectronics Corporation.

Dr Kenneth McLeod obtained his doctoral degree in electrical engineering from the Massachusetts Institute of Technology, US. His research is focussed on musculoskeletal adaptation, with a particular focus on electromagnetic interactions with living tissue. Kenneth serves as Director of the Clinical Science and Engineering Research Laboratory at the State University of New York in Binghamton, US.
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Dr Sree Koneru
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Dr Kenneth McLeod
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