Sixteen months separate two transactions that, taken together, tell us more about where musculoskeletal medicine is heading than most corporate strategy presentations. In February 2025, Globus Medical agreed to buy Nevro Corp., the spinal cord stimulation company, for roughly $250 million in cash. This week, Zimmer Biomet announced it will pay up to $140 million for iovera°, the drug-free cryoneurolysis device owned by Pacira BioSciences — $70 million upfront, with another $70 million tied to revenue milestones running through 2031.
Two of the largest orthopedic and spine companies in the world are buying pain assets. Neither deal moves the needle on its own. As a pattern, they are hard to ignore.
Surgery treats pathology. Pain defines the episode.
Orthopedic and spine companies have traditionally sold to a narrow moment: the procedure itself. The implant goes in, the case closes, revenue gets booked. But the patient’s journey runs from first complaint to final follow-up, and so does the payer’s math. Pain is what connects everything. It is the reason the patient shows up in the first place, and in the era of same-day discharge it has become the single biggest operational constraint.
This last point is worth dwelling on. The migration of joint replacement and spine procedures to ambulatory surgery centers depends almost entirely on opioid-sparing pain control. A patient who cannot manage pain without IV narcotics does not go home the same day, full stop. Whoever controls the perioperative pain pathway ends up controlling the ASC economics, and increasingly the site-of-care decision itself.
For Zimmer Biomet, iovera° fits neatly. The device applies focused cold to a target nerve, temporarily blocking its ability to transmit pain signals, and carries an indication for knee osteoarthritis pain relief lasting up to 90 days. Performed a few weeks before a total knee replacement, cryoneurolysis reduces postoperative opioid requirements. Zimmer can now sell a pain solution attached to the front end of its flagship knee franchise. This is not diversification away from orthopedics. It is a way of thickening its grip on the knee episode.
The regulatory tailwind
There is a policy story underneath both deals, and it matters. Years of opioid litigation turned non-pharmacologic pain management into a political priority in the United States, and that priority now has a reimbursement mechanism: legislation that came into effect last year expands access to non-opioid pain treatments, creating separate payment for alternatives that previously had to compete against opioids costing pennies per dose. When Washington starts subsidizing a category, strategic buyers show up. The timing here is no coincidence.
Distressed assets at unusual prices
There is a less flattering reading, and it deserves space. Neither company paid growth multiples, mainly because neither target was growing.
Nevro generated an estimated $408.5 million in worldwide revenue in 2024, which means Globus paid around 0.6 times sales for a business that once carried a multi-billion-dollar valuation. Even with a 27% premium over the 90-day average price, this was a rescue valuation for an SCS market squeezed by utilization pressure and entrenched competition from Medtronic, Boston Scientific and Abbott.
Zimmer’s deal structure is even more revealing. Half the consideration is contingent, with milestone tranches that trigger only if iovera° reaches $50 million, $60 million or $70 million in annual net revenue between 2027 and 2031. Pacira itself paid $220 million for this technology when it acquired Myoscience back in 2019. Seven years later, Zimmer takes it for potentially a third less, with downside protection built into the contract. Draw your own conclusions about conviction levels.
What it means for spine
For spine specifically, Globus–Nevro is the combination to watch. Chronic low back pain is the largest patient funnel in all of musculoskeletal medicine, and the vast majority of those patients never become fusion candidates. A spine company that owns neuromodulation captures revenue from patients it previously referred away, while keeping a relationship with those who may eventually convert to surgery. Nevro also brings a sacroiliac joint fusion platform, which means Globus now touches the back pain patient at nearly every decision point along the care pathway.
Medtronic, Boston Scientific and Abbott built neuromodulation as a standalone specialty. Globus and Zimmer are doing something different: attaching pain to the surgical episode, through the same surgeon call point they already own. It is a different sales motion, and the incumbents have not faced it before.
Execution still pending
Buying cheap assets in struggling categories only looks brilliant in hindsight, and only if execution follows. SCS has disappointed nearly everyone who has touched it this decade. iovera° never scaled under Pacira, despite a genuine clinical rationale and years of trying. The strategic logic behind both deals holds up well on paper. Whether the commercial results follow is another question, and for both companies the second act will be considerably harder than the signing.
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