To measure and track pain, Israeli duo develops ‘objective’ monitor

One August morning in 2014, Yariv Adan, a senior product manager for Google in Zurich, was riding his motorcycle to work on a scenic mountain road when things went very wrong. His accident left him with an injured spine, a cracked scapula, broken bones and torn muscles.

He has learned to live with the paralysis of his right arm. But the pain, his constant companion, was a different story.

“Imagine presenting or interviewing with strong pain. Imagine waking up multiple times every night because of pain. Imagine pain always there with you  —  on your vacation, kid’s birthday, long business trip, when you drive, when you kiss  —  e-v-e-r-y day for the rest of your life,” Adan wrote in a blog post in March 2018, describing his situation.

Then one day his second cousin Ariel Assaf, an Israeli-US serial entrepreneur who sold his data-center analytics startup Cloudoscope to Hewlett Packard, complained to Adan that he was looking for his next “significant” project and was having trouble coming up with an idea worth pursuing.

Ariel Assaf, left, and Yariv Adan, the co-founders of Lab 39 which has created the Genie app to track pain; Jan 1, 2019 (Shoshanna Solomon/Times of Israel)

They tossed a few ideas around, and then decided that perhaps Adan’s predicament was a challenge worth taking up.

“Talking to him I realized just how frustrated he was about his pain and about how little modern medicine had to offer him,” Assaf said in an interview with The Times of Israel in Tel Aviv, where he now lives. Not only that, Adan described to Assaf the frustration of the doctors themselves, who felt helpless regarding his pain.

“That surprised me,” Assaf said. “So I started talking to pain doctors in the US and Europe and I heard a shockingly constant story: they feel they are treating patients in the dark, and the remedies they offered were not evidence-based. They were very upfront about how frustrated they are by the lack of evidence and jealous of other fields that have measures with which they can work.”

Doctors today mainly attempt to measure pain by asking their patients questions. In 2011, David Borsook, a pain researcher at McLean Hospital and Harvard Medical School said that finding an objective measure of pain could radically change how patients are treated.

Doctors measured Adan’s pain by asking questions such as: how much pain do you feel, on a scale from 1 to 10? How much pain have you felt in the past three weeks? Are you doing better or worse; how are you sleeping; how have you been functioning?

The answers, of course, are subjective. “Pain changes during the day,” said Adan, 44, who was on a visit to Tel Aviv earlier this month. “How can I remember what it was three weeks ago?”

Yariv Adan, the co-founder of Lab 39 that aims to help doctors and patients better monitor pain (Google)

Pain, explained Assaf, is stored in the brain’s short-term memory. “We don’t want to remember pain,” he said. “So, we forget.” So a doctor who asks questions “knows you cannot really answer, and that he is making life altering decisions based on these answers.”

Even if there are neural signals that can be monitored in the brain, related to pain, explained Assaf, “we would call those signals pain only if they correlate to what the subject reports as pain, so the subjective nature of the measure remains. ”

“We looked at the problem and realized that it is a data analytics problem,” Assaf said.

So in 2017 the duo founded US-based startup Lab 39, which developed the Genie. This wristband with sensors, made using existing off-the-shelf hardware, partners with a smartphone app to help track pain. The wristband tracks sleep patterns, physical activity and heart rate — all of which are known to react to pain — while the app asks the patients a number of times a day how they feel, which they answer by swiping a pain scale. In addition, the app offers patients access to information and articles and also short relaxation exercises that could help them alleviate the feeling of pain.

All of this information is then sent to the cloud and doctors are provided with an analysis of the data collected, allowing them over time to identify patterns of how the patient reacted to meds, for example, or how pain is reduced after a better night’s sleep.

“With the technology, doctors will now be able to just look at a chart, just as they would for blood pressure, which is the way it should be,” said Assaf.

The product has been distributed to a variety of doctors to try out and to patients at a pain clinic at Duke University Hospital in North Carolina, for feedback. “The technology is being used successfully and continues to evolve,” Assaf said.

Willing to try new ways to help relieve pain

In medical devices, he added, one of the challenges is getting doctors on board with new technology. “What is unique with us is that the doctors are frustrated, and are willing to try new things,” Assaf said. “All of the doctors we approached, at Columbia University, Stanford University, at the Henry Ford Health System, asked when can we do this.”

Nirmish Shah, an assistant professor of medicine at Duke University School of Medicine, a pediatric hematologist specializing in sickle cell, has joined the firm as a co-founder.

Adan — who is a co-founder of Lab 39 but does not take an active part in the day-to-day dealings of the startup because of his job in Google — is the technology’s lead user, testing it out on himself.

“I have four kids,” Adan said. “I don’t want to deal with pain all the time, even to report it.” Thus, he said, the app aims to be easy-to-use, avoiding having users linger on the fact that they are in pain.

The market scope of the product is a “green field” of opportunity, they said. There are more than 25 million chronic pain sufferers in the US alone, according to the US National Institutes of Health, with 23.4 million American adults reporting “a lot of pain.”

After getting doctors on board to prescribe the product, they said, the next step will be to get the insurance companies to refund patients’ costs.

The entrepreneurs are now looking to raise funds to further develop the product and get it past the necessary regulatory and insurance approvals.

“My dream is to say one day that through my pain, I managed to help alleviate the pain of millions of others,” Adan said.

Full disclosure: Ariel Assaf lives next door to this reporter.