June 30, 2016 | June 2016 issue
June 30, 2016 | Scarred by the loss of reimbursement for TENS devices from CMS and the demise of Empi, the surface stimulation market is on a slow but steady rebound. For more than 30 years, the market was dominated by TENS devices mainly for the treatment of pain. Many of the competitors in this space were gobbled up by DJO Global (formerly Encore Medical). The stream of acquisitions included vendors like Empi, Chattanooga Group, and Compex Technologies. Declining revenues and the CMS decision caused DJO to divest its Empi unit late last year.
The firms that survived are still around and even more are beginning to enter the market. The key for them is not to concentrate on pain but to expand into alternative applications. For instance, neuromuscular stimulation for rehabilitation has been gaining traction. Neurotech Reports forecasts that muscle stimulators along with neural reeducation systems will produce a $200-million market this year. There are many vendors in the rehabilitation space such as Zynex Medical with its Neuromove device, Curatronic with Biomove Home devices, and MyndTech with its MyndMove system. Each is specifically targeting the rehabilitation market and the stroke segment in particular. Helius Medical is also getting into the rehabilitation market with its PoNS device paired with therapeutic exercise for functional gains from traumatic brain injury. The research is in partnership with the U.S. Army Medical Department.
Alternative applications are also emerging. CerboMed GmbH is developing surface vagus nerve stimulation for the treatment of epilepsy along with chronic pain. The company’s Nemos t-VS device is CE marked for the treatment of epilepsy, depression, and pain. ElectroCore Medical in Morris Plains, NJ is commercializing a surface stimulation device for respiratory disorders such as asthma and COPD as well as therapies for serious headache conditions including migraine and cluster headaches.
NeuroSigma has also entered the space with a noninvasive trigeminal nerve stimulation system designed to treat neurological and psychiatric conditions such as Lennox-Gastaut syndrome, ADHD, PTSD, and TBI. They have already received CE Mark and Canadian approval for drug-resistant epilepsy and major depressive disorders.
The fitness market is yet another area where surface stimulation is ripe for expansion. Compex USA, still part of DJO Global, has taken the muscle stimulation market to a new level by offering a line of “performance muscle stimulators” targeted specifically for competitive athletes to gain an edge without the fear of failing a drug test. Marketing directly to consumers with the nod of the FDA, Compex’ suite of muscle stimulators is recommended to be coupled with athletic training and workouts to gain muscle strength and functional performance in a wide ranges of sports from tennis to swimming to triathlons.
Still, the players in the surface stimulation market have not abandoned the pain market, and have taken one of two strategies; absorb any demand that remained from Empi’s exit and amend the therapy application. Familiar names like RS Medical, Dynatronics, Electromedical Products International, Medical Science Products, and Zynex Medical all are offering TENS units for pain relief. There are also new entrants like VQ OrthoCare and Zimmer Medizin Systems.
Adding to the mix, Biowave and SPR Therapeutics offer percutaneous stimulation for deep tissue pain relief with the convenience of a mobile device. Another new direction is wearable pain devices from companies like Axiobionics and RS Medical. Vendors have even expanded into the direct to consumer marketplace. Neuormetrix announced at the 2015 Consumer Electronics Show the release of Quell, an over the counter wearable pain relief device. On their coat tails is Carex Health Brands, a division of Compass Health, offering direct to consumer remote control pain relief devices labeled under the brand name of AccuRelief.
At first glance, surface stimulation may seem like a small market place in the overall neurotech industry. Couple the surface stimulation options in rehabilitation, neuromodulation for pain relief, and cognitive disorders as well as the open fitness market and the surface stimulation market grows to more than half a billon dollars. The industry has taken several punches over the last few years, but it has healed and come back as a new force.
Update: See this commentary from the July 2016 issue for an update on the surface stimulation market.
