In the midst of an opioid crisis and growing frustration over limited pain treatment options, a Boston-based life sciences startup is taking a bold step to rewrite the narrative. Brixton Biosciences, co-founded by Sameer Sabir, is leading the charge with Neural Ice, an innovative, non-pharmacological injectable solution that promises long-lasting pain relief without the addictive baggage of opioids or the diminishing returns of steroid injections.

In an exclusive interview, Sabir detailed the need for such a solution, the science behind Neural Ice, and how this technology could usher in a new era in pain management – one that prioritizes efficacy, safety, and patient experience.

The status quo: A system in pain

Pain management in the US is often a maze of inadequate, short-term fixes that leave millions suffering. “Pain management encompasses a lot of different areas,” Sabir explains. “Broadly, we differentiate between acute pain – like post-operative pain – and chronic pain, such as that caused by osteoarthritis. In both, there’s a huge unmet need.”

Sabir describes the typical treatment pathway for knee osteoarthritis, Brixton’s first target indication: conservative therapies like NSAIDs and physical therapy come first, followed by steroid injections.

“But steroids don’t treat the pain directly,” he says. “They target the inflammation causing the pain. And while a first shot might help, subsequent injections damage cartilage, so clinicians are limited in how often they can use them.”

When steroids stop working, patients might try viscosupplements – lubricating injections that studies show are largely ineffective—or expensive, unproven regenerative therapies like PRP (platelet-rich plasma).

“Even though major clinical guidelines don’t support these treatments, we still see about $1 billion spent annually on viscosupplements in the US,” Sabir says.

For advanced cases, more invasive procedures like radiofrequency ablation are options – but they’re complex and have limited success. Ultimately, many patients find themselves pushed toward joint replacement surgery sooner than ideal. “And that’s not always possible,” Sabir adds. “Patients who are too young, overweight, or have other health issues may not qualify for surgery at all.”

The acute pain space fares no better. Sabir points to knee replacement surgery – “historically the number one surgery leading to opioid addiction”—as an example. Local anesthetics like lidocaine wear off within a day or so, and many patients end up on opioids for weeks post-op. Though recent advances such as Exparel (a longer-lasting anesthetic) and new oral treatments like Journay PM offer some hope, they fall short of dramatically shifting the paradigm.

“In summary,” Sabir says, “significant gaps remain in our ability to manage both acute and chronic pain. Neural Ice aims to address those.”

A frozen solution with fiery potential

So what is Neural Ice – and how is it different?

“Neural Ice is a frozen, injectable solution that’s delivered near the nerve,” Sabir explains. “But unlike cryotherapy, which uses extreme cold via probes at –60°C, our formulation is injected at around –7°C. It then melts slowly around the nerve, extracting energy and causing selective lipolysis of the myelin sheath.”

This process leads to a temporary desensitization of the nerve through a biological mechanism known as Wallerian Degeneration. “It’s not just blocking the nerve, like traditional anesthetics – it’s biologically remodeling it for extended relief. The result is an ultra-long-acting, reversible nerve block.”

And because Neural Ice is made entirely of inert, non-drug components, it sidesteps the safety, regulatory, and abuse concerns associated with opioids or biologic drugs.

Evidence in action: Months of relief

Brixton has already conducted pilot human safety studies targeting knee osteoarthritis. “On average, patients experienced 4–6 months of significant pain relief,” says Sabir. Side effects were minimal – mostly mild injection-site discomfort.

But reliability might be Neural Ice’s biggest strength. “Early data suggests a high rate of consistent response. Patients who struggled to walk are now climbing stairs, biking, sleeping better, and using fewer systemic medications.”

This promising profile helped Brixton earn FDA Breakthrough Device Designation, which is reserved for technologies with the potential to offer significant advantages over existing options. The company has now launched a 270-patient randomized controlled trial comparing Neural Ice to steroid injections, with full enrollment expected by the end of 2025.

Brixton isn’t stopping at knees. “We’ve initiated pilot studies for lateral hip pain and received FDA approval for a trial in thumb joint arthritis,” Sabir says. “Eventually, we’ll pursue acute indications too – starting with post-knee arthroplasty.”

Tackling the opioid Crisis, joint by joint

With the opioid epidemic still casting a long shadow over American healthcare, Neural Ice offers a welcome departure. But Sabir is measured in his optimism.

“To be clear, Neural Ice works where we can identify the specific nerve transmitting the pain,” he says. “In complex trauma or systemic pain conditions, opioids may still be necessary. But in chronic joint pain or post-surgical recovery, we see a clear opportunity to reduce or even eliminate opioid use.”

He says: “The overuse of NSAIDs and steroids is now rising, and these carry their own long-term risks. Neural Ice offers a targeted, non-systemic alternative.”

Asked about potential resistance from prescribers, Sabir is pragmatic. “Pain studies are notoriously difficult, so we’re focused on building a solid body of Level 1 clinical evidence – joint by joint. In the end, it will come down to the data.”

Navigating the regulatory path

Despite its novel mechanism, Neural Ice will be regulated as a medical device, not a drug – a classification that Brixton believes plays to its strengths. “Because we’re drug-free and operate through a functional mechanism, we avoid many of the hurdles faced by traditional pharmaceuticals,” says Sabir.

That status also opens the door to strategic reimbursement pathways. “We’ll apply for a Transitional Pass-Through Payment (TPT) from Medicare,” he explains. “If approved, this would provide separate reimbursement for the first three years post-launch, helping to speed adoption in both private and public healthcare systems.”

Voices from the front lines

Feedback from physicians involved in early trials has been “overwhelmingly positive,” according to Sabir. “The most rewarding part is seeing patients regain their quality of life – walking further, sleeping better, engaging in activities they’d given up on.”

He adds that many misconceptions center around the mechanism. “Some assume it’s just another nerve block or a form of cryotherapy. But it’s neither. Once clinicians understand the biological remodeling involved, they get excited about the potential.”

Putting patients first

Perhaps most importantly, Sabir and the Brixton team are placing patient experience at the center of development. “We’re not just focused on efficacy – we’re constantly refining our approach to ensure the treatment is well tolerated,” he says.

That includes thoughtful consideration of procedure logistics, minimizing injection discomfort, and even involving patients in protocol design. “Pain management is increasingly patient-centered,” Sabir adds. “And that’s exactly how it should be.”

Looking Ahead

With Neural Ice now in pivotal trials and regulatory groundwork laid, Brixton Biosciences is aiming to bring its flagship product to market in the next few years. If successful, it could transform how chronic and acute pain are treated – offering a safer, longer-lasting alternative to a flawed status quo.

“For millions living with pain, there are few good options,” Sabir says. “We’re working to change that – not incrementally, but fundamentally.”

As the clinical data builds and the opioid era continues to wane, Brixton’s freeze-first, drug-free approach may well represent the next generation in pain relief: effective, enduring, and tailored to the patient – not just the symptom.