Saluda Medical’s Fight for a Slice of a Multi-Billion Dollar Pain Market

Saluda Medical CFO Jim Erickson explains how a spinal cord stimulator that corrects itself 50 times a second is taking on the world’s biggest med-tech players, and what the company must prove next.

The Pain Behind the Market

Roughly one in four American adults lives with chronic pain, and its annual cost in the US exceeds that of heart disease, cancer and diabetes combined. For patients at the severe end, one of the few real options is a device implanted near the spine that interrupts the pain signal before it reaches the brain.

Jim joined Saluda in November 2023, while it was still private, and it listed on the ASX in December 2025. Before that he spent a decade at Tornier, ran the global integration office through the Wright Medical merger, and served as both CFO and head of marketing at Monteris.

Spinal cord stimulation has been around for more than 30 years. It uses electricity to block pain signals on their way to the brain, and it is usually the last stop on a long road. On average, patients have lived with chronic pain for about 12 years before they get one, after back surgeries and opioids. Many are in severe pain most of the time, with depression and other mental health problems alongside it.

Why a Fixed Dose Falls Short

Traditional systems deliver a fixed output of energy. The trouble is that the amount the spinal cord actually absorbs changes as the patient moves, changes posture or takes medication.

As you live your life, you’re moving around, the amount of that energy that’s absorbed by the spinal cord is changing constantly. And so you get a very inconsistent therapy from a traditional technology.

— Jim Erickson

Patients end up overstimulated and in discomfort, so they turn the device down until it stops working properly. The physician has little to go on beyond asking how the patient feels.

All a physician really has to go by traditionally is to ask a patient, ‘How are you feeling?’ ‘What’s your pain on a scale of one to 10?’

— Jim Erickson

Evoke uses the same hardware, but it also measures how strongly the nerve activates in response to each pulse. That tells the physician how much therapy the patient is really getting, and it lets the system adjust the energy 50 times a second to keep relief consistent, more than four million corrections a day. Jim says this goes after the two problems that have dogged the market for years: how long relief lasts, and the constant return visits, every month or two, to have the system readjusted by the manufacturer’s rep.

The Explant Problem

When relief fades and the device needs constant tuning, some patients simply want it out. Jim puts the explant rate across the market at about 10% at one year and 22% at two years, and it keeps compounding the longer the device is in.

Insurance carriers don’t like it. They don’t like having to pay for a procedure that ultimately is gonna end up being reversed, and then they pay for the reversal.

— Jim Erickson

Saluda’s answer is its three-year randomised controlled trial, run as part of its US approval. Patients in the closed-loop arm had no explants due to loss of efficacy at three years.

The obvious criticism is that trials are not the real world. Jim points to a presentation at a major pain conference in Miami by Dr Jason Pope, a single-centre user in California, who reviewed about 140 of his own Evoke patients, roughly 90 of them a year or more out. The results mirrored the trial, with no explants for loss of efficacy. A few devices still come out for infection or surgical issues, which Jim says sit outside the system’s ability to operate. For Jim, matching trial results in the commercial world is what is getting physicians excited.

A New CEO, and a Strategy Built Together

Earlier in the week Saluda announced that Chief Commercial Officer Mark Matthias would become CEO. Jim joined about two and a half years ago and Mark about a year later, so Mark has been with the company just short of two years.

Mark began his career at Medtronic, where he helped build the TAVR business in cardiac from very little to something much bigger, competing with the likes of Edwards. He then worked at smaller device companies, setting the strategy for building a commercial ramp from the beginning. Jim says that is exactly where Saluda is now. Mark also carried an early spinal cord stimulator as a young sales rep and fell in love with helping chronic pain patients.

He has a real passion for the impact technology can have on a patient’s life.

— Jim Erickson

When Mark arrived, Saluda was at the start of its US commercial ramp. The two worked closely to reset the strategy: the profile of salesperson to hire, a scalable training program and a proper sales process. Jim is clear that a process is not the same as a script.

It’s not about making a robotic sale. It’s about figuring out the steps, the tools, the things that have worked best to take a new physician unaware of your technology through the journey of understanding the value proposition to being an advocate for the therapy.

— Jim Erickson

Taking on the Giants: Footprint Before Foothold

Saluda is not building a new market. Spinal cord stimulation is established, reimbursement codes exist, and the concept is well understood. That makes the ramp potentially quicker, since reps are educating on a value proposition rather than persuading doctors to change how they treat, but it is also a far more competitive fight.

The competitors are Medtronic, Abbott, Boston Scientific and Globus, which acquired Nevro. These are some of the biggest medical device companies in the world, with existing businesses of several hundred million dollars in this space and large sales forces that are always in the room.

Going to market and trying to say, ‘Hey, maybe we’ll just hire 5, 10, 15 reps, start in a couple of cities and see what we can do,’ I have found in a really big competitive market like that is really hard to actually get much foothold.

— Jim Erickson

Saluda’s strategy was to build a real footprint. At the start of FY25 its reps covered only about a third of the US market. The aim was to get closer to half, enough presence for hospitals and physicians to see the company as a committed, long-term option, without trying to hire a rep for every territory in the country.

Three Years In: US$90 Million and a Tipping Point

Saluda’s first full year of commercial launch in the US was FY24, and it has just finished FY26. In that year it did about US$90 million in revenue, a little over US$60 million of it in the US and roughly US$25 million outside it.

Jim is candid that the first year of the US launch did not have quite the right strategy at its centre, and that a sharper early focus might have put the number even higher.

If we’re self-critical a little bit, I think we had to reset a little bit a couple years ago to kinda get this footprint in place.

— Jim Erickson

The payoff showed up late in the year. US revenue grew more than 40% in both the third and fourth quarters of FY26, and in the fourth quarter the US business implanted 50% more patients than a year earlier. About half of that growth came from new physicians and half from existing physicians using the device more, so adoption is deepening as well as widening.

The sales force tells the same story:

• FY25: an average of about 55 fully trained US sales reps.
• FY26: an average of about 89 fully trained reps, up almost 60%.
• End of FY26: 161 reps in total, with about 40% still finishing their training in early FY27.
• Onboarding: roughly six months of training before a rep gets a quota, which means a large group of new reps is still ramping into FY27.

The Paddle Lead: Unlocking a Third of the Market

Today’s Evoke uses a percutaneous lead. It is placed through a small needle, much like an epidural, into the space beside the spinal cord, and pain specialists implant it as a minimally invasive procedure. The paddle lead is a flat lead placed surgically by a neurosurgeon under general anaesthesia, usually after removing a small piece of bone. It is sutured more securely and covers more area.

Some pain specialists prefer not to do the procedure themselves and refer patients to neurosurgeons who favour paddles. Because Saluda launched without one, about a third of the US market has been out of reach.

We’re the first paddle lead on the market that’s doing any kind of sensing as a part of a closed loop therapy.

— Jim Erickson

The FDA approved the paddle at the very end of June, after Saluda spent time educating the agency on how the sensing works. A limited launch is now under way, and Jim expects it to be a big part of growth in FY27 and beyond.

The existing sales force can sell it. The sales process and call points are largely the same, since the therapy decision often starts with a pain physician before a referral to the neurosurgeon. Saluda has already completed paddle training for the whole team and had been hiring reps into paddle-heavy regions ahead of approval.

From Headcount to Territory Profitability

Asked what investors should watch beyond revenue and EBITDA, Jim says the story is moving from building the sales force to proving its productivity. Saluda will keep adding people, but at a much slower rate.

I always like to talk about it as profitability at the territory level.

— Jim Erickson

Reps must be at the trial procedure, the initial programming, the permanent implant and any later adjustments. Closed loop means far fewer adjustments, but not zero, and Jim believes the lower care burden will let reps spend more of their time on revenue-generating work than on the care continuum.

The metric is the cost of covering a territory as a share of the revenue it generates. At the end of FY26 it was about 75%, which Jim admits is really high, partly because a big part of the sales force has no revenue to its name yet. But a third of the more established territories are already below 40%. The goal is to get to sub-30% and into the 20% range.

If your sales force is in that low to mid-20% range, you got a very profitable sales force, and that is a business that can really operate going forward.

— Jim Erickson

That is the thesis Saluda now wants to prove: a much more efficient sales force that can keep growing while bringing its cost per revenue dollar down to traditional med-tech levels.