CUR are the makers of a patch that uses TENS technology to deliver pain relief without expensive machinery. The company was founded by Shaun Rahimi after he discovered the magic of TENS machines, but was frustrated by their inability to reach the people that need them the most. We sat down with Shaun to discuss FDA clearance, finding co-founders and how to bring a medical device to life.
We make products that help you reduce pain and stay active without drugs. Our first product is a 2 x 5 inch electronic patch that you can use to stop muscle and joint pain within seconds. It delivers a form of TENS (transcutaneous electrical nerve stimulation) therapy. It’s a technology that’s used by physicians and athletic trainers of top NFL and NBA teams to reduce pain and swelling. In those environments, it’s very complicated, bulky, and comes in the form of big icebox-like machines. CUR uses biometric sensors—accelerometer and bioimpedance—to automate the treatment process so all you have to do to use it is place it like a band-aid and wait a few seconds for relief.
I’ve been working in medical devices since I was about 15 years old at different startups. Mostly as an R&D engineer; developing implantable neurostimulators, stents and artificial heart valves. I worked on invasive, FDA-regulated medical devices at companies like Neuropace and Abbott Labs from the age of 15 until I was about 21.
While working on a heart valve replacement device during college, I developed carpal tunnel syndrome in both my arms from straining myself on a repetitive process. I had lived with back pain since I was about 8 or 9 due to issues with scoliosis and a spine condition called Scheurmann’s kyphosis.
My work injury caused pain in my wrists, but also exacerbated my back condition to the point where I lived with debilitating back and arm pain for two years. During this time I tried physical therapy, acupuncture, and all sorts of different drugs—enough drugs to the point where I don’t remember my third year of college from all of the side effects.
I was desperate and trying to find a solution and started talking to as many doctors and fellow patients to learn what I could. After two years of searching, one of my dad’s friends, who was a physiatrist in Cupertino, brought me this big, ice-box looking machine. He called it a TENS machine and it had lots of buttons and wires on it. It came out to these two sticky pads and he placed the two pads on my wrist. After he applied the pads, he started pressing a few buttons and within 10 seconds of using the device I noticed the pain in my wrist vanished, and turned into this warm, pleasurable sensation.
I was surprised by what happened to my arm; after living with pain for two years the doctor had just “turned off” my pain. I was confused and surprised, but really grateful so I took the device home. He let me borrow it for a few months. I started using it every day, sometimes up to six to eight hours in a given day between my wrist and my neck.
After about two months I recovered from about 90% of my pain. I was able to control my pain without side effects for the first time in a long time. I started working out, I started sleeping better, my appetite returned and I started eating better. I had this experience where I experienced an initial, “What the hell is this relief?” epiphany, followed by a more substantial life-changing event when I used the device to actually resolve my pain. At that point, I was confused. I thought, “Why aren’t these things more popular? There are so many people that live with pain, why aren’t other people like me using these devices?” Then I did some research and I noticed there are a lot of people actually using these devices, and they actually are really popular. Just about every pain and physical therapy office uses a TENS machine on their patients. Just about every NFL, NHL, and NBA team has a TENS device in their locker room to use before and after games.
They’re seemed to be popular in clinical and athletic settings, but not among consumers. Once I started thinking about this, I realized a few problems. First, they were big. Second, they’re also really expensive—they’re several thousand dollars. Third, the most important problem I noticed was that they’re really complicated to use, especially the more professional ones that are able to deliver the greatest, prescription-level type of relief. The advanced settings like waveform, modulation pattern and frequency made them more complicated but also much more effective since the physician could target the pain very specifically.
I noticed that there was this treatment that was really effective and useful, but too complicated for people to use without a doctor’s help. At that point I started wondering: how cool would it be if there was a simple and affordable way to experience this form of relief? The metaphor of a band-aid was really interesting to me so eventually this evolved the question to be: what if there was a band-aid that you could apply to relieve any type of muscle or joint pain in a few seconds?
I then started working with our co-founder and Chief Technology Officer, Kevin McCullough—a talented electronics engineer—to build a prototype. We experimented with sensors for months to try to build an automated, “one touch” solution for delivering TENS therapy. We wanted to find a way to deliver an effective result with a single button press so people wouldn’t have to understand how to adjust the frequency and modulation settings like a doctor would. After about six months of experimenting, we built a functional prototype for a “smart band-aid” that you could place on your back and wear around the house comfortably. We would apply it, press a button and it delivered targeted and accurate TENS treatment within five seconds.
“We knew that we'd built something very meaningful and useful.”
I actually had started to try to work on that prototype with five or six people and faced different issues with personality and culture fit—one of the more common issues in early stage companies. Just like when you’re on a bad date, you know when your group is not a good fit.
When I met Kevin he had a product engineering firm called Gecko Engineering. He had single-handedly built entire electronics products—software and hardware—for Stryker, Microsoft and Parallax Semiconductor. I called him up one day and he seemed really smart and he knew about the technology and how to build it, and he basically promised to build it in a third of the time and a fifth of the cost than any other firm that I had been talking with. After working with him for two months, we built the prototype up and we pressed the button, and went through the whole process of getting it adjusted and it was working. We looked at each other and we were like, “What did we just do?”
We knew that we’d built something very meaningful and useful. Both of Kevin’s parents both live with debilitating forms of chronic back pain and so he understood the problem we were solving and how important what we had in front of us was. We worked well together initially and after actually finishing an initial version of the product, the growing momentum of our progress and friendship led us to put everything that we had into working together.
We were first-time entrepreneurs, and we didn’t have many resources, especially cash. We knew we could go through the process of building a company regardless, but also that having an extra $50,000 would offset some of the debt that we’re dealing with, as well as having a network of people went beyond the connections we had already established. We we’re trying to learn as fast as possible and an accelerator seemed to make sense because it provided a larger network of people to tap into and learn from almost immediately.
“Whenever I have a problem I either put some data around it or I visit an overwhelming amount of smart, experienced entrepreneurs and I asked for their advice on the decision.”
The biggest hurdle has been making it clear to people that we have a credible, ethical approach to pain. The best way to prove that is to put it on someone and show that it solves pain, like in an in-person demo or video. The problem with our product is that due to regulatory constraints and the lack of an FDA clearance, we can’t actually distribute units or show the device working on people. That’s been a big hurdle, not being able to put it on people and show the value of what we are doing in a public and obvious way. That said, I think there’s a lot of science around what we’re doing. With TENS, there’s a lot of critical research that shows it works, so that’s been helpful to allaying that concern from investors and strategic partners. We’ve got a lot of interest from athletes, and professional sports teams in the NBA, NHL and NFL and from well-known pain and orthopedic physicians.
It hasn’t been as difficult with these folks because we are solving a problem that physicians and athletes are familiar with—the need to simplify a form of pain relief that works really well but is too complicated for people to use without a doctor’s help. When we explain the science behind our approach they get it and understand why an automated system allows their patients to use the treatment at home and while they are active during training. Some of the athletes that we’ve been talking with even want to use the device during games. That said, we’re not marketing yet. We can’t market it yet. I can’t distribute these devices, I can’t put them on people, I can’t start selling them either, so that’s all related to the fact that we don’t have FDA clearance, which I think is reasonable, but unfortunately is also a limiting factor for building the business.
The process is focused around testing the functional qualities of our electronics. We basically test our device and show that the nature of the electronics is safe and can lead to an effective results by comparing it to the design of an existing TENS machine. The testing process takes several months which is followed by an FDA submission. Then you wait a few months to hear back from the FDA that you are cleared to begin selling and distributing units, so in total it can take a year to complete.
“Given the remarkable nature of the product, focusing on influencers makes a lot of sense for us.”
There are different types of medical devices, but for a device that you’re expecting consumers to pay out-of-pocket for like ours, you need to make sure the economics work out. People aren’t usually used to buying their medical devices at the grocery store.
For example, selling a glucose meter is something that even glucose meter companies right now are not doing very much of. They’re giving them away to users and their revenue counts on subsequent purchases of the disposable sensors required to test with the device. Now, if you’re developing a medical device and you are selling via prescription, the key is figuring out who’s going to pay for this from the insurance standpoint. Who are the payers or insurers for this type of product, and what do they need to see in order to reimburse for this? Are there existing reimbursement codes for this treatment? What clinical studies do you need to run to prove that it helps insurers treat patients better and save them money?
If you want to sell to consumers directly, you want to figure out what it takes to find your customer, to sell to that customer and then get more customers like that customer—a typical problem for a consumer product. The challenge for most traditional medical devices is oftentimes that your consumer isn’t just everyone. Everyone needs a bed, or a toothbrush, but does everyone need a glucose meter? Not really. For this reason, finding your customer and communicating with them in an efficient way can be more challenging with medical devices. Thankfully for us, muscle and joint pain is a big enough problem in America that this is not as much of a challenge for us.
Running a small experiment with 50 to 100 people, showing them the products if they’re the target user, and asking them if they’re willing to pay for it at the end of a demo: that’s an important step. That’s one we took with our earlier prototypes which was very successful.
The strategy for a product like ours is to earn credibility from influential physicians and celebrities, and not just one or two, but an entire sports league. We then tie that back into a website that promotes the trial of the product or the demo of the product, or somehow gets people to try it or want it. Given the remarkable nature of the product, focusing on influencers makes a lot of sense for us. When that happens, plaster that info on your marketing and get people to see how many other credible perspectives are using your product. It gives your product and brand a sense of credibility. Take that credibility and understanding, and get people to expose themselves to the product as much as possible.
Now if you have a medical product that works 10x better than existing treatments, defensible IP that protects other people from copying you, and evidence that you have an efficient way to sell it and motivate others to sell it for you —that is a very good start.
A standard piece of advice is to use empirical evidence when making really serious decisions. If you’re going to launch a product and you have 10 possible solutions to a problem, you should run some sort of test to back your assumptions about those ideas. Whenever I have a problem I either put some data around it or I visit an overwhelming amount of smart, experienced entrepreneurs and I asked for their advice on the decision. Either of these usually solves the problem.
What’s your current state of mind?
Comfortable, focused, confident
When and where are you happiest?
Outside on a on a warm/sunny day.
What is your greatest fear?
Losing touch with people I love and care about.
What is your greatest extravagance?
Which talent would you most like to have?
What is your most treasured possession?
What is your greatest regret?
Not connecting with certain people.
What’s your favorite quote?
“It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better... The credit belongs to the man who spends himself in a worthy cause; who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat.” -Teddy Roosevelt
What do you consider the most overrated virtue?
What book are you reading right now?
Fooled by Randomness by Nasim Taleb
We’re going to release the product in a more public way early next year with influential sports teams and physicians. We’ll be providing a solution to an important problem and I think we’ll be able to develop a lot of interesting content, especially videos. We’ll be continuing to build out and releasing updated versions of the software as time goes on so the experience will be constantly improving. There are a lot of interesting ideas around the app and we’ve developed ways that you can get value out of the product even if you don’t live with chronic pain.