NeuroMetrix Quell: What Did People with Chronic Neuropathy Pain Say About the New Pain Relief Device?

By Alexander Wolf

Twitter Summary: Five ppl w/ diabetic neuropathy test drive #Quell pain relief device – what did they like + how can it be made even better?

Since the launch of the Quell chronic pain management device this past summer, our team has been eager to learn about users’ real-world experience to treat the pain and discomfort associated with diabetic neuropathy. Thanks to help from the diabetes market research company dQ&A, we invited five volunteers with diabetic neuropathy or other forms of chronic pain to use the no-prescription-required (“over-the-counter”), FDA-cleared Quell device and app for two weeks. Read below for more information on Quell and what these five people had to say about it!

Bottom Line: Quell offers a potentially life-changing experience for people suffering from chronic pain. While the cost may be high for some ($249 upfront + $30 per month), we see it as a low-risk (there’s a money-back guarantee), high-reward opportunity to significantly improve quality of life for people living with often debilitating diabetic neuropathy. For sure, there will be some who experience no pain relief from Quell (~20% of people, according to NeuroMetrix), and others more who will find the burden of wearing the calf-worn device to outweigh the pain relief it provides. Still, chronic pain remains a major unmet need in diabetes, and many people have experienced very limited success from pain medications alone. We applaud NeuroMetrix for an innovative, effective, FDA-cleared product that clearly incorporated a lot of thinking on the patient experience.

Plus – fresh out of the Consumer Electronics Show – it was just announced that a second-generation version of Quell has received FDA clearance. This updated version contains advancements in tracking capabilities, an extended battery life of up to 25%, and more. It will be available in March of 2016 – more details below! 

What is Quell and how much does it cost?

The Quell device is worn on the calf and uses nerve stimulation to treat multiple types of chronic pain, including diabetic neuropathy and fibromyalgia. The product is about the same thickness as an iPhone 5, is relatively lightweight, and its strap resembles a sports band that can easily be hidden under clothes. The device pairs with a free smartphone app for tracking and reminders. Quell stands out as one of the only FDA cleared non-drug therapies for chronic pain relief, eliminating many of the side effects that come with common pain medications.

Quell is available for purchase online here at $249 for the device “starter kit,” followed by $30 for each month’s worth of supplies. Quell is actually an “over-the-counter” version (no prescription needed) of the previous prescription-only NeuroMetrix device, Sensus.

How does it work?

Quell is worn in a strap that wraps around the upper calf, sending electrical pulses through the skin to the sensory nerves that in turn signal the brain to trigger the body’s natural pain relief response, blocking pain signals throughout the body. It is similar conceptually to TENS (transcutaneous electrical nerve stimulation), but developed in a wearable form and is more sophisticated, stronger, and optimized for diabetes nerve pain. It can be worn for long periods of time, including during sleep. While the device is worn around the leg, it can relieve chronic pain throughout the body (i.e., back pain, foot pain, etc.). It even works in both legs when worn on a single leg, and can be worn 24/7, if desired.

What is the Quell app?

The calf-worn Quell device is Bluetooth-connected to an optional smartphone app (both Apple and Android) that tracks the treatment time, battery life, and sleep quality. “Treatments” come in 60-minute on/off intervals, and the battery life display conveniently shows how many treatments are left (for example; 75% battery, 15 treatments). Quell can last for up to 40 hours before needing to be plugged in to recharge, though the average user gets around 30 hours of battery life – this comes out to about five days between charges on average. The device works without the app.

Who should consider Quell?

• Those who experience chronic pain of all kinds (including diabetic neuropathy/ diabetic foot pain). The one exception is chronic migraines or headaches, which would not be treated by Quell.

• People who are unable to relieve chronic pain with pain medication, or who experience negative side effects with pain medications.

• People who are able to pay an ongoing price of $30/month for Quell supplies, on top of the upfront cost of $249.

• Those with a smartphone or tablet (Android or Apple), which gives access to an optional app that allows for further individualization and tracking.

What features come in the upgraded version of Quell?

The upgraded Quell, available in March of 2016, comes with several updates geared at user convenience and data analysis. These include:

• Extended battery life of up to 25%

• The ability control the device straight from the app, allowing users to turn the device on/off and to change the intensity of treatments from their smartphones

• Advanced sleep tracking technology that monitors length and quality of sleep (including how the user moves and sleeps, such as body position, repetitive leg movements, and major body shifts).

• A second treatment mode with a unique physical sensation – NeuroMetrix describes the standard stimulation as a “comfortable constant vibration,” whereas the new stimulation feels like a “gentle pulse”

• Enhanced data tracking, providing trend reports of all therapy and sleep data at time scales ranging from one day to three months

The updated Quell does not have any changes in effectiveness or physical design (i.e., same thickness, same strap, etc.). It will be priced the same as the previous Quell system, and NeuroMetrix is offering a free upgrade program for current users who send in their previous generation devices.

Test Driving Quell – Insights from People with Diabetic Neuropathy

Our Quell test drive features five volunteers with diabetic neuropathy who used the Quell device for a two-week period. We thank these participants tremendously for working with us on this project and providing their personal insights on Quell!

Our test drive participants all had unique experiences with the device – some found that it could noticeably reduce their chronic pain, whereas others saw minor to no impact. This is to be expected, as the NeuroMetrix team explains that Quell is effective in about 80% of those who use it (consistent with our Test Drive, in which only one person reported no pain relief at all). We note that in some cases, users don’t experience the full benefits of Quell until after three to four weeks, so our Test Drive may not capture the absolute experience of using Quell in all participants.

We’re providing testimonials from the participants below, categorized by different aspects of the Quell experience: setting it up, experiencing pain relief, wearing the device, and using the mobile app. Additionally, we’ve summarized the experiences of the participants to give a more holistic view of each person’s test drive.

SUMMARY OF EXPERIENCES

BETTY: Betty (55) has type 2 diabetes and has had chronic pain – including pain from diabetic neuropathy, back pain, arthritis, and fibromyalgia – for over 20 years now. Considering herself a “drug-free” person, she is strongly against using pills and other drugs to treat her own pain, fearing the negative side effects that can come with medications and the risk of becoming drug-dependent. She cited a past encounter with pain medications that caused her to feel “out of it” and overly tired for three days straight, preventing her from adequately monitoring and controlling her diabetes.

Betty rated her pain prior to using Quell as a 10 out of 10 (where 10 is unbearable pain), and found that Quell almost immediately brought relief down to a 1 out of 10.

She found the device simple to set-up and easy to wear, and was happy to find a non-medication solution to her chronic pain. To us, this is a testament to all the work put in by the NeuroMetrix team; they are working incredibly hard to bring relief to patients and a response like Betty. Even though not everyone has this response, if a sub-group of patients do, it’s a win. 

VIRGINIA: Virginia (64) has type 2 diabetes and has been living with diabetic neuropathy for just over a decade. Prior to using Quell, she had been experiencing leg and foot pain, which she ranked from a 7-10 out of 10 (where 10 is unbearable pain).

Virginia experienced tremendous pain relief from Quell, which she emphasized only improved as she continued to wear it.

While she found electrode’s adhesion irritated her skin a bit, she found the device was also very easy to set up and was not cumbersome at all to wear. For her, the tradeoff was worth it.

BOB: Bob (61) has type 2 diabetes and been living with diabetic neuropathy for two to four years.

Bob experienced moderate pain relief from Quell (25-30% reduction, he claimed), though it was not as much as it could have been.

He said the instructions were a “breeze,” but found physically wearing it to be bothersome – particularly at night, and even stopped wearing it while he was sleeping after a few days into the test drive (though continued daytime wear).

MICHAEL: Michael (68) has type 2 diabetes and has had a history of chronic back pain, involving surgical interventions in the past, and also reported severe pins and needles pain in his hands. He has also previously had his right leg amputated.

While Michael found the Quell device a bit difficult to set up and wished for a longer battery life*, it led to significant pain relief. He also said he really enjoyed using the mobile app – it sounds easy and engaging from his report.

He was particularly satisfied with how it helped his hand pain, though it did lead to unexpected minor levels of elevated phantom pain in his phantom right limb.

*Editor’s note: the updated version of Quell will come with a 25% greater battery life.

Peta-Gaye: Peta-Gaye (35) has type 1 diabetes and has lived with diabetic neuropathy for 6-8 years now.

Peta-Gaye also found it difficult to set up Quell (though the mobile app helped), and unfortunately did not receive any pain relief from wearing Quell.

She even found it caused some added pain, which she described as “feeling like it was pulling at my [nonexistent] leg hair” when wearing the device. As such, she stopped using Quell after one week. She also found it a bit clunky to wear, but said that if it caused significant pain relief, the burden of wearing it would have been worth it. We found this interesting, and believe making for an easier set-up seems possible.

SET UP

Bottom Line: Overall, Quell was simple to set up for most (but not all) participants, coming with clear instructions and easy-to-assemble parts. Those who used the mobile app said it made the process much easier than without it.

Pros:

• “The instructions were very easy. It took no time at all to get it going. The whole thing was easy…Other than the pain relief, [the fact that] it was easy was the best part.” -Virginia

• “Setting it up was a breeze – the instructions were pretty straightforward and it was just a matter of making sure it was fully charged (it came fully charged) and then putting it together.” –Bob

• “My favorite thing about Quell was the pain relief and that it was easy to use, and that you don’t have to swallow a pill for it.” -Betty

Cons:

• “The instructions weren’t helpful. It didn’t even tell me about downloading the app. It was only when you [diaTribe] told me about the app that it started to make sense.” –Peta-Gaye

• “It took me a while to set up…The instructions needed to go into a bit more detail.” –Michael

EXPERIENCING PAIN RELIEF

Bottom Line: While for most, the Quell device led to reductions in nerve pain, it had minor to no effect on others. Additionally, Quell’s impact on pain relief seemed to be very treatment-dependent. Rather than providing continuous pain relief throughout the day, participants noted that the pain relief was stronger when it was actively giving a treatment and weaker (or non-existent) when it was off-cycle. This is to be expected given the device’s mechanism of action: nerve stimulation is mostly effective when active and for 30-60 minutes after. Over a longer period of time, it may decrease the sensation of chronic pain more broadly, though this would not be captured in our two-week Test Drive.

We believe the company’s claim that Quell offers some relief for ~80% of wearers. But unfortunately, as with pain medications as well, it seems challenging to predict ahead of time whether or not Quell will work for any given person. NeuroMetrix offers a 60-day money back guarantee on all Quell purchases, so anyone who does not experience adequate pain relief from using Quell can return it for free. NeuroMetrix management told us that they are studying user data to try and build predictive analytics in the future.

Pros:

• “I’ve been experiencing neuropathy and other foot pain for 10-12 years now. It gets worse each year…On a scale of 1-10, it varied, but it was anywhere from a 7-10. Quell seemed to work really well. It helped a great deal with the pain. After a few hours, I noticed it. [At the end of two weeks], normally I would say it brought it down to a 2 out of 10. Because it’s been cold and raining, it’s maybe closer to a 4-5...The following morning when I got out of bed, I didn’t seem to be as stiff, and there was less pain. And it seemed to get better the longer I did it. It helped with all of the pain.” –Virginia

• “[My experience using Quell] went very well. I hooked it up and oh my god, I don’t know how it works, but it feels like it stops the motion of the pain. I just plugged it in, read the directions, turned it on, and I felt pain relief immediately…It helped both the neuropathy and the back pain.” –Betty

• “Before, my back was a 3-4 on a scale of 1-10. Now, it’s down to about a 2. It’s always there. So I am getting pain relief in my back…It does work. I’m very pleased with what it does to my hand. I couldn’t feel anything with my hands [before using Quell], now I can almost feel stuff! My hand pain used to be about a five (out of ten), but now I’m not feeling those pins and needles. It’s almost down to about a one.” –Michael

• “Quite honestly, I saw overall some improvement. There were times I wasn’t sure if it was doing anything. At best, a 25-30% improvement, which was positive. I saw more improvement when it was actually on. The tingling I got from the electrodes to me had a positive effect – it was quite noticeable, and that actually almost was a soothing effect.” -Bob

Cons:

• “I still felt lightning bolts of pain in my legs and my ankles. There was no noticeable difference…Each time I would walk with it on my leg, it felt like it was pulling my hair on my legs, even though I shaved and didn’t have hair. The machine felt like it was sticking to me when I moved, and it became so painful it felt like it was giving me little shocks. I had to stop using it after a week. Even just moving my foot or turning on my side made it hurt.” –Peta-Gaye

•  “I get a lot of phantom pain…it seems to have increased the phantom pain a bit. When my left ankle hurts, I get some phantom pain in my right ankle. That seems to have increased a bit, and when it does I take a vicodin. The pain seems to be in cycle for when [Quell] is doing it’s treatments.” -Michael

• “It didn’t provide a continuous [pain relief] effect when it wasn’t giving a treatment.” -Bob

WEARING THE DEVICE

Bottom Line: It takes a while to get used to wearing Quell on the calf, but it seemed to feel less bothersome over time for most people. It was less noticeable during the daytime, and can be easily hidden beneath clothing. At night, though, more people found it bothersome to wear. Moreover, the electrode-adhesive pulled at some peoples’ skin a bit, particularly when walking or moving.

Pros:

• “I noticed it a lot the first little while, but after that I easily forgot I had it on. It wasn’t cumbersome at all.” –Virginia

•  “When I was awake, I had to get used to it. I didn’t have the wrap real tight – I had it snug, but the weight of the unit would tend to cause it to pull down. I had to get used to wrapping it tighter. [After some time] when I was awake, I had no problems with it. –Bob

• “I sure didn’t find it hard to wear…If I wake up at night and feel pain, I’d get up and put it on and go back to sleep” –Betty

Cons:

• “I only had one problem the whole time…the little sticker things, they sometimes really hurt when I pulled those off.” –Virginia

• "When I tried to use it when I was asleep, that did not work for me. When it was loose enough that it was comfortable, it came off. The electrodes stayed in place but the wrap and the unit came off. If it was tight enough to stay on, that was uncomfortable. I used it for three of four nights, after that stopped. It did tend to wake me up a couple times throughout the night.” –Bob

• “I was wearing it 24/7, even to work. It was a little bit bulky, but I had my pants covering it. When I took it off to give it a break, I was able to put it on my other leg. I wish you could wear it and hide it elsewhere on your body.” –Peta-Gaye

MOBILE APP

Bottom Line: Users agreed, downloading the mobile app enhanced the experience of using Quell and made it simpler to track treatments and battery life.

Pros:

• “[The mobile app] is great! I check it all the time now.” -Michael

• “The app was helpful…[the device] went well with the app.” –Peta-Gaye

• “I used the mobile app. It showed the history, whether it was on or off, the time remaining for treatments, how many times it had been used, and that sort of thing. I did use that.” -Bob

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