Spinal Cord Stimulators For Chronic Pain: Interview With Charlie Covert, VP and GM, Pain Therapies,

Chronic pain is a difficult burden to bear, but advances in spinal stimulators are helping suitable patients to gain some control over their infliction. Medtronic is a major player in this space, and is continually developing its spinal cord stimulators to better address patient and clinician needs.

For instance, the company announced the release of the FDA-approved Vanta neurostimulator last summer. The recharge-free device allows full-body MRI access, personalized programming, and can provide over seven years of service (depending on settings). The new implant is also smaller and thinner than previous incarnations, and boasts superior longevity compared with various competitor devices using similar settings.

The company is also developing Differential Target Multiplexed stimulation, which acts on different areas of the spinal cord. A recent study showed that the technique provides additional benefits in terms of pain suppression compared with conventional spinal cord stimulation.

Medgadget had the opportunity to speak with Charlie Covert, Vice President and General Manager, Pain Therapies, Medtronic, about their range of spinal cord stimulation technologies.

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Conn Hastings, Medgadget: Please tell us about your background. How did you end up in your current role?

Charlie Covert, Medtronic: My experience in the medical device industry spans about two decades. I started working for Medtronic over 15 years ago, spending the majority of my time in commercial, strategy, and business development roles. Prior to my current role, I led Medtronic’s targeted drug delivery business, and prior to that, led marketing and strategy for our pacemaker business that launched the Micra transcatheter pacemaker. I also led product planning for our first Bluetooth-enabled platforms in that business.

In 2018, I assumed the role of General Manager for our Implantable Pain Therapies business, which is comprised of our spinal cord stimulation (SCS) and targeted drug delivery (TDD) technologies. Implantable Pain Therapies is part of our Neuromodulation operating unit.

Medgadget: Spinal cord stimulation is a chronic pain therapy that has been around for several decades. How has the technology evolved in recent years? What’s new?

Charlie Covert: Chronic pain is a debilitating condition, and symptoms can persist over years for many patients. Medtronic pioneered spinal cord stimulation more than a 40-years ago.

We have also made strides in recent years to take this technology further. Features like more efficient, longer lasting batteries, smaller and more contoured devices for comfort, broader MRI access, more robust data reporting for physicians, and personalized stimulation thanks to AdaptiveStim™ technology, which automatically adjusts stimulation based on the patient’s body positions.

Perhaps our most consequential new technology in this space is DTM™ SCS therapy, which coordinates multiple signals at multiple anatomical targets and is proven superior to conventional SCS. Unlike conventional SCS, Differential Target Multiplexed (DTM) stimulation targets different areas of the spinal cord – hence, Differential Target – with different signals or frequencies—hence, Multiplexed. Our randomized, controlled trial for DTM SCS, the results of which were published in Pain Practice Journal, showed 84% of chronic back pain patients treated with DTM™ SCS reported at least 50% pain relief, compared with only 51% of conventional SCS patients at 12 months. Data has shown DTM™ SCS therapy with the Intellis™ platform provides superior, sustained, and profound back pain relief.

Medgadget: Patients have an option between rechargeable and recharge-free implantable spinal cord stimulators, but historically Medtronic has not been a major player in the recharge-free segment of this market. How are you looking at this space and patient population?

Charlie Covert: While it’s true that we have not historically made a lot of noise in the recharge-free segment of this market, which represents about a quarter of all chronic pain patients, that is no longer the case with the launch of our FDA-approved Vanta™ neurostimulator this past summer. Vanta is a high-performance recharge-free neurostimulator that can be paired with our latest therapy, DTM SCS endurance therapy, to offer patients meaningful pain relief and an estimated 5.5-7.5 years of longevity based on actual programmed settings from our study. Early response from customers has been overwhelmingly positive and we look forward to growing our market share in this segment over the coming years.

Medgadget: The pandemic has changed how many people visit with their doctors, with more remote interactions and virtual visits. What challenges and opportunities might this create for patients with chronic pain, and how is Medtronic approaching this shift?

Charlie Covert: The COVID-19 pandemic forced many people to adapt their lifestyle to a “new normal,” and that includes how they interact with their healthcare providers. We looked at ways to meet patients (and their care providers) where they are, and these days that is online. This past May, we launched CareGuidePro™, which serves as a virtual guide for patients throughout their Medtronic spinal cord stimulation therapy journey. This app allows patients to record their pain relief and other feedback directly into the app, which can be used by Medtronic and the patient’s health care provider to make more informed therapy decisions.

Medgadget: What is your vision for Medtronic’s future in pain therapies? Where are you taking the business from here?

Charlie Covert: With our company mission to alleviate pain, restore health, and extend life, Medtronic strives to be at the forefront of medical device innovation. We pioneered the field of neuromodulation over 40 years ago and we remain committed to delivering innovative therapy and technology solutions that are deeply grounded in clinical evidence.

There are a couple of strategies we’re pursuing to fulfill this mission. First, we are focused on reaching more patients in more places. We can do this through indication expansion of our current platforms, for example with patients with Non-Surgical Refractory back pain (NSRBP) and Upper Limb pain. These are conditions we are looking to treat in the future and we are working hard to develop the clinical evidence necessary for these approvals. We also just announced FDA approval for treating patients with Diabetic Peripheral Neuropathy which represents a substantial opportunity given the prevalence of that condition and the need for effective treatment options.

Second, Medtronic is advancing closed-loop spinal cord stimulation technology designed to enable clinicians to deliver optimized therapies based on patient needs. Our closed-loop approach is based on Evoked Compound Action Potential (ECAPs), which are signals generated by the spinal cord in response to an electrical stimulus. These signals can guide dynamic, real-time therapy adjustments to respond to the patient’s unique needs. We believe this will enhance outcomes, and we are committed to building on our early clinical experience in this area to demonstrate this. So, it’s an exciting time to be in this business for sure, and we look forward to continuing along this innovation journey and reaching more patients in new ways.

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