In late 2019, one of the world’s largest biotechnology companies made a decision that, little did it know, would help usher forward a new era of pain management.

Amgen’s choice to mostly exit brain drug research wasn’t out of the blue. Neuroscience, even in the labyrinthine world of drugmaking, is notoriously risky and expensive, and its challenges have convinced many developers their dollars would be better spent elsewhere. After Amgen joined that list, some of its laid off staff found new roles just down the street from the company’s Los Angeles-area headquarters, at a startup formed by venture capitalists at Westlake BioPartners.

For Westlake, the moment was right to jump into a branch of science three decades in the making, where researchers had uncovered that certain nanoscopic tubes in the outer layers of cells play a key role in pain. These “sodium ion channels” are tricky to study and even harder to control. But years of slow, grueling experimentation was finally paying off.

Pain, being a virtually universal human experience, has long been a white whale opportunity for drug hunters. If anyone could find a strong analgesic that’s safer than opioids, the social and financial payoffs would be massive. In other words, a smart bet for Westlake — which, by itself and with relatively little funding, got that startup, Latigo Biotherapeutics, off the ground in 2020.

“It was a basic benchtop science exercise, knowing that on the other side there could be a GLP-1-like, decabillion-dollar market,” David Allison, a managing director at the firm, said in an interview in late November.

Yet, when the Westlake team pitched Latigo to fellow investors the following year, Allison recalls a less-than-enthusiastic reception. They didn’t care to gamble on pain pills, even novel ones, at a time when cutting-edge genetic medicines were promising to cure an array of devastating diseases. “Most people said: ‘A pain company in 2021? You’re crazy.’”

Five years later, Westlake is vindicated. Latigo raised $150 million from a funding round announced last March, right as Journavx — a first-of-its-kind ion channel blocker from Vertex Pharmaceuticals — launched in the U.S. Though it took a quarter century to bear fruit, Vertex’s work has started to revive a graveyard area of drug development. A handful of companies are following in its footsteps with similar medicines, including pharmaceutical giant Eli Lilly.

Pain drug research now faces a pivotal moment. For major investments to continue, the field must soon deliver assets worth rallying around beyond Journavx and its closest rivals. That’s proving difficult, as testing new painkillers remains an all but insurmountable task.

Journavx itself is not yet the roaring success some had hoped. Despite being exquisitely designed, it appears about as potent as a weak opioid, leaving doctors unsure when and where it’s most useful and researchers pondering whether drugs like this have a firm limit to their power. To craft something superior is a daunting enough premise that it could dissuade more developers from even trying.

On Wall Street, the early buzz surrounding Journavx has quieted amid disappointing first-year sales. Analysts don’t foresee revenue drastically ramping until the drug gets OK’d for a wider range of painful conditions.

“Excitement is definitely there,” said Phil Nadeau, an analyst at TD Cowen who covers Vertex. “But, ultimately, we'll need some examples of successful commercial development for that enthusiasm to persist.”

A rare victory

Pain is exceedingly tough to define and defeat, a gnawing reminder of how much we still don’t understand about our own biology. Until Journavx, there hadn’t been a truly innovative medication for it cleared in the U.S. in over two decades.

Journavx won approval in early 2025, as a treatment for the short-lived “acute” pain typically felt after an accident or operation. It was, as Nadeau describes, a “watershed moment,” providing a desperately needed non-addictive option at a time when millions of Americans each year report misusing a prescription opioid. Overdose deaths involving these drugs are still in the thousands annually.

Doctors are now using Journavx after everything from knee replacements to shoulder surgeries to wisdom teeth extractions. In April, total prescriptions surpassed 1 million.

“We've seen great receptivity, particularly in those institutions keen to move away from opioids as much as possible,” said Duncan McKechnie, who, as Vertex’s chief commercial officer, is overseeing the rollout. “We're really pleased with the progress so far, but we're a long way to go to transform the treatment of pain worldwide.”

High demand hasn’t made the launch frictionless — or cheap. Last year, Journavx was the main culprit behind a 20%, or almost $300 million, surge in Vertex’s overhead costs. For the first time, the company turned to marketing tactics from big pharma’s playbook. It bought ads for TV, Instagram and YouTube, partnered with high-profile athletes like Jayson Tatum and Alex Smith, and is in talks with Lindsey Vonn.

Spending looks poised to grow further, as Vertex just a few weeks ago doubled the size of its Journavx sales force, from 150 to 300, in an effort to sway more physicians to routinely reach for the pill.

While many drug launches come with a learning curve, Vertex doesn’t seem to be driving sales fast enough to appease shareholders. Journavx generated just shy of $90 million in its first year on the market. Over most of that period, its performance fell below analyst forecasts.

“Certainly, people don't feel as bullish about the drug as they did a year ago,” said Paul Matteis, an analyst at Stifel.

To Allison, Journavx has done as well as anyone could have anticipated. Even so, an argument could be made that if the drug were under the banner of a company with a sweeping, more primary care-leaning sales team, then it would be closer to meeting the blue sky, “zero-to-a-billion-in-how-many-quarters” bar set by some.