1
|
Sander MY, Zhu X. Infrared neuromodulation-a review. REPORTS ON PROGRESS IN PHYSICS. PHYSICAL SOCIETY (GREAT BRITAIN) 2024; 87:066701. [PMID: 38701769 DOI: 10.1088/1361-6633/ad4729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 05/03/2024] [Indexed: 05/05/2024]
Abstract
Infrared (IR) neuromodulation (INM) is an emerging light-based neuromodulation approach that can reversibly control neuronal and muscular activities through the transient and localized deposition of pulsed IR light without requiring any chemical or genetic pre-treatment of the target cells. Though the efficacy and short-term safety of INM have been widely demonstrated in both peripheral and central nervous systems, the investigations of the detailed cellular and biological processes and the underlying biophysical mechanisms are still ongoing. In this review, we discuss the current research progress in the INM field with a focus on the more recently discovered IR nerve inhibition. Major biophysical mechanisms associated with IR nerve stimulation are summarized. As the INM effects are primarily attributed to the spatiotemporal thermal transients induced by water and tissue absorption of pulsed IR light, temperature monitoring techniques and simulation models adopted in INM studies are discussed. Potential translational applications, current limitations, and challenges of the field are elucidated to provide guidance for future INM research and advancement.
Collapse
Affiliation(s)
- Michelle Y Sander
- Department of Electrical and Computer Engineering, Boston University, 8 Saint Mary's Street, Boston, MA 02215, United States of America
- Department of Biomedical Engineering, Boston University, 44 Cummington Mall, Boston, MA 02215, United States of America
- Division of Materials Science and Engineering, Boston University, 15 Saint Mary's Street, Brookline, MA 02446, United States of America
- Photonics Center, Boston University, 8 Saint Mary's Street, Boston, MA 02215, United States of America
- Neurophotonics Center, Boston University, 24 Cummington Mall, Boston, MA 02215, United States of America
| | - Xuedong Zhu
- Department of Biomedical Engineering, Boston University, 44 Cummington Mall, Boston, MA 02215, United States of America
- Photonics Center, Boston University, 8 Saint Mary's Street, Boston, MA 02215, United States of America
- Neurophotonics Center, Boston University, 24 Cummington Mall, Boston, MA 02215, United States of America
| |
Collapse
|
2
|
Florence TJ, Bari A, Vivas AC. Functional Stimulation and Imaging to Predict Neuromodulation of Chronic Low Back Pain. Neurosurg Clin N Am 2024; 35:191-197. [PMID: 38423734 DOI: 10.1016/j.nec.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Back pain is one of the most common aversive sensations in human experience. Pain is not limited to the sensory transduction of tissue damage; rather, it encompasses a range of nervous system activities including lateral modulation, long-distance transmission, encoding, and decoding. Although spine surgery may address peripheral pain generators directly, aberrant signals along canonical aversive pathways and maladaptive influence of affective and cognitive states can result in persistent subjective pain refractory to classical surgical intervention. The clinical identification of who will benefit from surgery-and who will not-is increasingly grounded in neurophysiology.
Collapse
Affiliation(s)
- Timothy J Florence
- UCLA Neurosurgery, 300 Stein Plaza Driveway, Suite 562, Los Angeles, CA 90095, USA
| | - Ausaf Bari
- UCLA Neurosurgery, 300 Stein Plaza Driveway, Suite 562, Los Angeles, CA 90095, USA
| | - Andrew C Vivas
- UCLA Neurosurgery, 300 Stein Plaza Driveway, Suite 562, Los Angeles, CA 90095, USA.
| |
Collapse
|
3
|
Beauchene C, Zurn CA, Ehrens D, Duff I, Duan W, Caterina M, Guan Y, Sarma SV. Steering Toward Normative Wide-Dynamic-Range Neuron Activity in Nerve-Injured Rats With Closed-Loop Peripheral Nerve Stimulation. Neuromodulation 2023; 26:552-562. [PMID: 36402658 PMCID: PMC10081946 DOI: 10.1016/j.neurom.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 09/08/2022] [Accepted: 09/30/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Chronic pain is primarily treated with pharmaceuticals, but the effects remain unsatisfactory. A promising alternative therapy is peripheral nerve stimulation (PNS), but it has been associated with suboptimal efficacy because its modulation mechanisms are not clear and the current therapies are primarily open loop (ie, manually adjusting the stimulation parameters). In this study, we developed a proof-of-concept computational modeling as the first step toward implementing closed-loop PNS in future biological studies. When developing new pain therapies, a useful pain biomarker is the wide-dynamic-range (WDR) neuron activity in the dorsal horn. In healthy animals, the WDR neuron activity occurs in a stereotyped manner; however, this response profile can vary widely after nerve injury to create a chronic pain condition. We hypothesized that if injury-induced changes of neuronal response can be normalized to resemble those of a healthy condition, the pathological aspects of pain may be treated while maintaining protective physiological nociception. MATERIALS AND METHODS Using an in vivo electrophysiology data set of WDR neuron recordings obtained in nerve-injured rats and naïve rats, we constructed sets of linear phenomenologic models of WDR firing rate during windup stimulation for both conditions. Then, we applied robust control systems techniques to identify a closed-loop PNS controller, which can drive the dynamics of WDR neuron response in neuropathic pain model into ranges associated with normal physiological pain. RESULTS The sets of identified linear models can accurately predict, in silico, nonlinear neural responses to electrical stimulation of the peripheral nerve. In addition, we showed that continuous closed-loop control of PNS can be used to normalize WDR neuron firing responses in three injured cases. CONCLUSIONS In this proof-of-concept study, we show how tractable, linear mathematical models of pain-related neurotransmission can be used to inform the development of closed-loop PNS. This new application of robust control to neurotechnology may also be expanded and applied across other neuromodulation applications.
Collapse
Affiliation(s)
- Christine Beauchene
- Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | - Claire A Zurn
- Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Daniel Ehrens
- Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Irina Duff
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Wanru Duan
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael Caterina
- Department of Neurosurgery, Neurosurgery Pain Research Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Biological Chemistry, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yun Guan
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurosurgery, Neurosurgery Pain Research Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sridevi V Sarma
- Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, USA.
| |
Collapse
|
4
|
Torlak MS, Atıcı E, Cıbık M. Effects of Transcutaneous Occipital Nerve Stimulation and Instrument-Assisted Soft Tissue Mobilization in Chronic Migraine. J Manipulative Physiol Ther 2022. [DOI: 10.1016/j.jmpt.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
5
|
Strand N, D'Souza RS, Hagedorn JM, Pritzlaff S, Sayed D, Azeem N, Abd-Elsayed A, Escobar A, Huntoon MA, Lam CM, Deer TR. Evidence-Based Clinical Guidelines from the American Society of Pain and Neuroscience for the Use of Implantable Peripheral Nerve Stimulation in the Treatment of Chronic Pain. J Pain Res 2022; 15:2483-2504. [PMID: 36039168 PMCID: PMC9419727 DOI: 10.2147/jpr.s362204] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/29/2022] [Indexed: 12/17/2022] Open
Abstract
The objective of this peripheral nerve stimulation consensus guideline is to add to the current family of consensus practice guidelines and incorporate a systematic review process. The published literature was searched from relevant electronic databases, including PubMed, Scopus, Cochrane Central Register of Controlled Trials, and Web of Science from database inception to March 29, 2021. Inclusion criteria encompassed studies that described peripheral nerve stimulation in patients in terms of clinical outcomes for various pain conditions, physiological mechanism of action, surgical technique, technique of placement, and adverse events. Twenty randomized controlled trials and 33 prospective observational studies were included in the systematic review process. There is Level I evidence supporting the efficacy of PNS for treatment of chronic migraine headaches via occipital nerve stimulation; chronic hemiplegic shoulder pain via stimulation of nerves innervating the trapezius, supraspinatus, and deltoid muscles; failed back surgery syndrome via subcutaneous peripheral field stimulation; and lower extremity neuropathic and lower extremity post-amputation pain. Evidence from current Level I studies combined with newer technologies facilitating less invasive and easier electrode placement make peripheral nerve stimulation an attractive alternative for managing patients with complex pain disorders. Peripheral nerve stimulation should be used judiciously as an adjunct for chronic and acute postoperative pain following adequate patient screening and positive diagnostic nerve block or stimulation trial.
Collapse
Affiliation(s)
- Natalie Strand
- Department of Anesthesiology, Division of Pain Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Scott Pritzlaff
- Department of Anesthesiology and Pain Medicine, Division of Pain Medicine, University of California-Davis, Sacramento, CA, USA
| | - Dawood Sayed
- The University of Kansas Medical Center, Kansas City, KS, USA
| | - Nomen Azeem
- Florida Spine & Pain Specialists, Bradenton, FL, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | | | - Mark A Huntoon
- Department of Anesthesiology, Virginia Commonwealth University, Henrico, VA, USA
| | | | - Timothy R Deer
- The Spine and Nerve Center of the Virginias, Charleston, WV, USA
| |
Collapse
|
6
|
Peripheral Nerve Stimulation for Lower Extremity Pain. Biomedicines 2022; 10:biomedicines10071666. [PMID: 35884969 PMCID: PMC9313008 DOI: 10.3390/biomedicines10071666] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 11/22/2022] Open
Abstract
Peripheral nerve stimulation (PNS) is rapidly increasing in use. This interventional pain treatment modality involves modulating peripheral nerves for a variety of chronic pain conditions. This review evaluated its use specifically in the context of chronic lower extremity pain. Studies continue to elucidate the utility of PNS and better define indications, contraindications, as well as short- and long-term benefits of the procedure for the lower extremity. While large, prospective evidence is still lacking, the best available evidence suggests that improvements may be seen in pain scores, functionality, and opioid consumption. Overall, evidence synthesis suggests that PNS for the lower extremities may be a viable option for patients with chronic lower extremity pain.
Collapse
|
7
|
Hadaya J, Buckley U, Gurel NZ, Chan CA, Swid MA, Bhadra N, Vrabec TL, Hoang JD, Smith C, Shivkumar K, Ardell JL. Scalable and reversible axonal neuromodulation of the sympathetic chain for cardiac control. Am J Physiol Heart Circ Physiol 2022; 322:H105-H115. [PMID: 34860595 PMCID: PMC8714250 DOI: 10.1152/ajpheart.00568.2021] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Maladaptation of the sympathetic nervous system contributes to the progression of cardiovascular disease and risk for sudden cardiac death, the leading cause of mortality worldwide. Axonal modulation therapy (AMT) directed at the paravertebral chain blocks sympathetic efferent outflow to the heart and maybe a promising strategy to mitigate excess disease-associated sympathoexcitation. The present work evaluates AMT, directed at the sympathetic chain, in blocking sympathoexcitation using a porcine model. In anesthetized porcine (n = 14), we applied AMT to the right T1-T2 paravertebral chain and performed electrical stimulation of the distal portion of the right sympathetic chain (RSS). RSS-evoked changes in heart rate, contractility, ventricular activation recovery interval (ARI), and norepinephrine release were examined with and without kilohertz frequency alternating current block (KHFAC). To evaluate efficacy of AMT in the setting of sympathectomy, evaluations were performed in the intact state and repeated after left and bilateral sympathectomy. We found strong correlations between AMT intensity and block of sympathetic stimulation-evoked changes in cardiac electrical and mechanical indices (r = 0.83-0.96, effect size d = 1.9-5.7), as well as evidence of sustainability and memory. AMT significantly reduced RSS-evoked left ventricular interstitial norepinephrine release, as well as coronary sinus norepinephrine levels. Moreover, AMT remained efficacious following removal of the left sympathetic chain, with similar mitigation of evoked cardiac changes and reduction of catecholamine release. With growth of neuromodulation, an on-demand or reactionary system for reversible AMT may have therapeutic potential for cardiovascular disease-associated sympathoexcitation.NEW & NOTEWORTHY Autonomic imbalance and excess sympathetic activity have been implicated in the pathogenesis of cardiovascular disease and are targets for existing medical therapy. Neuromodulation may allow for control of sympathetic projections to the heart in an on-demand and reversible manner. This study provides proof-of-concept evidence that axonal modulation therapy (AMT) blocks sympathoexcitation by defining scalability, sustainability, and memory properties of AMT. Moreover, AMT directly reduces release of myocardial norepinephrine, a mediator of arrhythmias and heart failure.
Collapse
Affiliation(s)
- Joseph Hadaya
- 1Cardiac Arrhythmia Center and Neurocardiology Research Program of
Excellence, David Geffen School of Medicine at UCLA, Los Angeles, California,2UCLA Molecular, Cellular and Integrative Physiology
Program, Los Angeles, California
| | - Una Buckley
- 1Cardiac Arrhythmia Center and Neurocardiology Research Program of
Excellence, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Nil Z. Gurel
- 1Cardiac Arrhythmia Center and Neurocardiology Research Program of
Excellence, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Christopher A. Chan
- 1Cardiac Arrhythmia Center and Neurocardiology Research Program of
Excellence, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Mohammed A. Swid
- 1Cardiac Arrhythmia Center and Neurocardiology Research Program of
Excellence, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Niloy Bhadra
- 3Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center, Cleveland, Ohio,4Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Tina L. Vrabec
- 3Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center, Cleveland, Ohio,4Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Jonathan D. Hoang
- 1Cardiac Arrhythmia Center and Neurocardiology Research Program of
Excellence, David Geffen School of Medicine at UCLA, Los Angeles, California,2UCLA Molecular, Cellular and Integrative Physiology
Program, Los Angeles, California
| | - Corey Smith
- 5Department of Physiology and Biophysics, Case Western Reserve University, Cleveland, Ohio
| | - Kalyanam Shivkumar
- 1Cardiac Arrhythmia Center and Neurocardiology Research Program of
Excellence, David Geffen School of Medicine at UCLA, Los Angeles, California,2UCLA Molecular, Cellular and Integrative Physiology
Program, Los Angeles, California
| | - Jeffrey L. Ardell
- 1Cardiac Arrhythmia Center and Neurocardiology Research Program of
Excellence, David Geffen School of Medicine at UCLA, Los Angeles, California,2UCLA Molecular, Cellular and Integrative Physiology
Program, Los Angeles, California
| |
Collapse
|
8
|
Xu Q, Ford NC, He S, Huang Q, Anderson M, Chen Z, Yang F, Crawford LK, Caterina MJ, Guan Y, Dong X. Astrocytes contribute to pain gating in the spinal cord. SCIENCE ADVANCES 2021; 7:eabi6287. [PMID: 34730998 PMCID: PMC8565904 DOI: 10.1126/sciadv.abi6287] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 09/14/2021] [Indexed: 06/13/2023]
Abstract
Various pain therapies have been developed on the basis of the gate control theory of pain, which postulates that nonpainful sensory inputs mediated by large-diameter afferent fibers (Aβ-fibers) can attenuate noxious signals relayed to the brain. To date, this theory has focused only on neuronal mechanisms. Here, we identified an unprecedented function of astrocytes in the gating of nociceptive signals transmitted by neurokinin 1 receptor–positive (NK1R+) projection neurons in the spinal cord. Electrical stimulation of peripheral Aβ-fibers in naïve mice activated spinal astrocytes, which in turn induced long-term depression (LTD) in NK1R+ neurons and antinociception through activation of endogenous adenosinergic mechanisms. Suppression of astrocyte activation by pharmacologic, chemogenetic, and optogenetic manipulations blocked the induction of LTD in NK1R+ neurons and pain inhibition by Aβ-fiber stimulation. Collectively, our study introduces astrocytes as an important component of pain gating by activation of Aβ-fibers, which thus exert nonneuronal control of pain.
Collapse
Affiliation(s)
- Qian Xu
- The Solomon H. Snyder Department of Neuroscience, Center for Sensory Biology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Howard Hughes Medical Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Neil C. Ford
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shaoqiu He
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Qian Huang
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael Anderson
- The Solomon H. Snyder Department of Neuroscience, Center for Sensory Biology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zhiyong Chen
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Fei Yang
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - LaTasha K. Crawford
- Department of Biological Chemistry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael J. Caterina
- The Solomon H. Snyder Department of Neuroscience, Center for Sensory Biology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Biological Chemistry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurological Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yun Guan
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurological Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Xinzhong Dong
- The Solomon H. Snyder Department of Neuroscience, Center for Sensory Biology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Howard Hughes Medical Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurological Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
9
|
Górecki M, Czarnecki P. The influence of shoulder arthrodesis on the function of the upper limb in adult patients after a brachial plexus injury: a systematic literature review with elements of meta-analysis. EFORT Open Rev 2021; 6:797-807. [PMID: 34667651 PMCID: PMC8489470 DOI: 10.1302/2058-5241.6.200114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Based on the literature, 294 shoulder arthrodeses after brachial plexus injury in adults were assessed, mostly male; the mean age of the patients was 33 years, and the mean follow-up time was 5.5 years. The most common cause of injury was a traffic accident, especially on a motorcycle. Arthrodesis position ranged from 15 to 40 degrees of flexion, 15 to 60 degrees of abduction, and 0 to 50 degrees of internal rotation with the predominance of position by the 30-30-30 rule. Plates, screws, and external fixation were used for stabilization. The complication rate was at the level of 28%, the most common complication being delayed union or nonunion. Active movements of flexion and abduction averaged 61 and 56 degrees, respectively, while reaching the hand to the mouth, front pocket, and buttock was feasible for 69%, 71%, and 38%, respectively, after surgery. Shoulder pain was present in 77% of patients, and 28% experienced no relevant pain reduction after surgery. The subjective satisfaction rate was 82% based on significant improvement and satisfaction reported by patients after arthrodesis. Arthrodesis of the shoulder, in adult patients after brachial plexus palsy, can reduce shoulder pain, increase stability, and result in a range of motion that increases the possibility of carrying out everyday activities. This affects the high level of subjective patient satisfaction after surgery.
Cite this article: EFORT Open Rev 2021;6:797-807. DOI: 10.1302/2058-5241.6.200114
Collapse
Affiliation(s)
- Michał Górecki
- Department of Traumatology, Orthopaedics and Hand Surgery, Poznań University of Medical Sciences, Poznań, Poland
| | - Piotr Czarnecki
- Department of Traumatology, Orthopaedics and Hand Surgery, Poznań University of Medical Sciences, Poznań, Poland
| |
Collapse
|
10
|
Persaud-Sharma D, William Mallet J, Panjeton GD, Ogbemudia B, Ahmad A, Coombes S, Antony A. Neuromodulation Applications for Chronic Pain. J Med Device 2021. [DOI: 10.1115/1.4052123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Abstract
Chronic back pain is highly prevalent worldwide, affecting over 10% of the global population. It is a complex medical problem that affects individuals, families, and communities and has a costly economic impact through an impaired workforce. Pain mechanisms are complicated and include biological, psychological, and social components that can combine to drive unique pain experiences. Beyond conservative management with multimodal pharmacotherapy and more invasive surgical intervention for an identifiable anatomical abnormality, there are limited therapies for the resolution of chronic pain. However, exciting technological developments in spinal cord stimulation have renewed interest in neuromodulation for patients with refractory pain after both conservative and surgical management. Here, we review the efficacy of spinal cord stimulator technologies and other related technologies, including dorsal root ganglion stimulators and peripheral nerve stimulators, as well as highlight future areas of research.
Collapse
Affiliation(s)
- Dharam Persaud-Sharma
- Department of Anesthesiology, University of Florida College of Medicine, 1600 SW Archer Road, P.O. Box 100254, Gainesville, FL 32610-0254
| | - John William Mallet
- Department of Anesthesiology, University of Florida College of Medicine, 1600 SW Archer Road, P.O. Box 100254, Gainesville, FL 32610-0254
| | - Geoffrey Danial Panjeton
- Department of Anesthesiology, University of Florida College of Medicine, 1600 SW Archer Road, P.O. Box 100254, Gainesville, FL 32610-0254
| | - Blessing Ogbemudia
- Department of Anesthesiology, University of Florida College of Medicine, 1600 SW Archer Road, P.O. Box 100254, Gainesville, FL 32610-0254
| | - Affan Ahmad
- Department of Anesthesiology, University of Florida College of Medicine, 1600 SW Archer Road, P.O. Box 100254, Gainesville, FL 32610-0254
| | - Stephen Coombes
- Department of Applied Physiology and Kinesiology, University of Florida College of Health and Human Performance, 1864 Stadium Road, Gainesville, FL 32611
| | - Ajay Antony
- The Orthopedic Institute, 4500 W Newberry Road, Gainesville, FL 32607
| |
Collapse
|
11
|
Singh H, Gargya A, Lin T, Gulati A. Sciatic, Femoral, and Lateral Femoral Cutaneous Nerve Ultrasound-Guided Percutaneous Peripheral Nerve Stimulation. PAIN MEDICINE 2021; 21:S47-S50. [PMID: 32804221 DOI: 10.1093/pm/pnaa040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE With advances in peripheral nerve stimulation technology, there has been an emergence of new minimally invasive techniques to provide neurostimulation therapies for chronic pain. This technical note describes the utilization of ultrasonography for percutaneous placement of peripheral nerve stimulation leads at the sciatic, femoral, and lateral femoral cutaneous nerves. METHODS Ultrasound can be utilized to localize a specific nerve, view neighboring soft tissue anatomy, and plan a needle trajectory. Various ultrasound techniques and transducer orientations allow for multiple options for lead placement relative to the targeted nerve. CONCLUSIONS The option of ultrasound-guided percutaneous technique for neurostimulation lead placement allows this treatment modality to be made available to more patients with chronic pain in specific nerve distributions.
Collapse
Affiliation(s)
- Harmandeep Singh
- Department of Anesthesiology, New York Presbyterian Hospital, New York, New York.,Weill Cornell Medical College, New York, New York.,Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Akshat Gargya
- Department of Anesthesiology, New York Presbyterian Hospital, New York, New York.,Weill Cornell Medical College, New York, New York.,Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Tiffany Lin
- Department of Anesthesiology, New York Presbyterian Hospital, New York, New York.,Weill Cornell Medical College, New York, New York.,Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Amitabh Gulati
- Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| |
Collapse
|
12
|
Regnier SM, Chen J, Gabriel RA, Chakravarthy KV. A review of the StimRouter® peripheral neuromodulation system for chronic pain management. Pain Manag 2021; 11:227-236. [DOI: 10.2217/pmt-2020-0042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The StimRouter® peripheral nerve stimulation system created by Bioness, Inc., (CA, USA) is US FDA-approved for the treatment of peripheral mononeuropathy refractory to conservative medical management. StimRouter is a minimally invasive system that utilizes a subcutaneously implanted lead with integrated anchor and electrodes, and an external pulse generator to produce peripheral neuromodulation and achieve pain relief. Multiple published clinical trials reviewed here have shown the StimRouter system to have a high margin of safety, differentiating it from other existing peripheral neuromodulation systems requiring open surgical electrode placement and implantable pulse generators. These studies have also shown the StimRouter system to be efficacious in the treatment of multiple peripheral mononeuropathies; improving patient pain, activity levels and quality of life. StimRouter represents a feasible option for management of chronic peripheral mononeuropathy.
Collapse
Affiliation(s)
- Shane M Regnier
- Department of Anesthesiology & Pain Medicine, University of California San Diego, San Diego, CA 92037, USA
| | - Jeffrey Chen
- Department of Anesthesiology & Pain Medicine, University of California San Diego, San Diego, CA 92037, USA
- Department of Anesthesiology, VA San Diego Healthcare System, San Diego, CA 92161, USA
| | - Rodney A Gabriel
- Department of Anesthesiology & Pain Medicine, University of California San Diego, San Diego, CA 92037, USA
- Division of Biomedical Informatics, Department of Medicine, University of California San Diego, San Diego, CA 92037, USA
| | - Krishnan V Chakravarthy
- Department of Anesthesiology & Pain Medicine, University of California San Diego, San Diego, CA 92037, USA
- Department of Anesthesiology, VA San Diego Healthcare System, San Diego, CA 92161, USA
| |
Collapse
|
13
|
Ji MH, Moshfeghi DM, Periman L, Kading D, Matossian C, Walman G, Markham S, Mu A, Jayaram A, Gertner M, Karpecki P, Friedman NJ. Novel Extranasal Tear Stimulation: Pivotal Study Results. Transl Vis Sci Technol 2020; 9:23. [PMID: 33244443 PMCID: PMC7683850 DOI: 10.1167/tvst.9.12.23] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 10/07/2020] [Indexed: 01/15/2023] Open
Abstract
Purpose To evaluate the efficacy and safety of iTEAR, a novel, portable, sonic external neuromodulation device, for the treatment of dry eye disease (DED). Methods This was a multicenter, open-label, single-arm clinical trial that included adult patients with DED with a Schirmer score of ≤10 mm in at least one eye. Enrolled subjects were instructed to apply the study device at least twice per day for 30 seconds bilaterally to the external nasal nerve. After the initial baseline visit, patients were followed up at days 3, 14, 30, 90, and 180. The primary efficacy endpoint was the Schirmer index (change from unstimulated to stimulated tear production as measured by the Schirmer test) at day 30. The major secondary endpoint was the change in symptoms of DED at day 30 evaluated using the Ocular Surface Disease Index (OSDI). Results A total of 101 subjects evaluated at day 30 had a mean Schirmer index of 9.4 mm (95% confidence interval [CI], 7.4–11.3), and the baseline OSDI improved by an average of 14.4 (95% CI, 11.1–17.7). Both endpoints were highly statistically and clinically significant at all time points. There were two mild unanticipated adverse events definitely related to the device. Conclusions The safety and efficacy of the iTEAR device observed in this study support its indication for treating DED. Translational Relevance Neurostimulation has the potential to improve signs and symptoms of DED.
Collapse
Affiliation(s)
- Marco H Ji
- Horngren Family Vitreoretinal Center, Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA.,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Darius M Moshfeghi
- Horngren Family Vitreoretinal Center, Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | | | | | | | | | - Andy Mu
- NV Eye Surgery, Las Vegas, NV, USA
| | - Ann Jayaram
- Mid-Peninsula Ophthalmology Medical Group, Menlo Park, CA, USA
| | | | | | - Neil J Friedman
- Mid-Peninsula Ophthalmology Medical Group, Menlo Park, CA, USA
| |
Collapse
|
14
|
Cai MM, Zhang J. Effectiveness of transcutaneous electrical stimulation combined with artificial tears for the treatment of dry eye: A randomized controlled trial. Exp Ther Med 2020; 20:175. [PMID: 33093910 PMCID: PMC7571363 DOI: 10.3892/etm.2020.9305] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 09/02/2020] [Indexed: 02/07/2023] Open
Abstract
There is currently no available cure or universally effective treatment for dry eye (DE). The aim of the present study was to investigate the clinical efficacy of transcutaneous electrical stimulation (TES) combined with artificial tears in treating DE. Patients diagnosed with DE were referred for therapy with TES combined with sodium hyaluronate (SH)-containing artificial tears. A total of 52 patients (104 eyes) with DE were enrolled in this randomized controlled trial. The patients were randomized 1:1 to the TES + SH or SH group. The patients in the TES + SH group were treated with 20 sessions (5 sessions per week for 4 weeks), and each session lasted for 20 min. The treatment was continued for 4 weeks in all cases. The Ocular Surface Disease Index (OSDI), tear film breakup time (BUT), Schirmer's I test and corneal fluorescein scores were used to assess treatment efficacy. A total of 90 eyes of 45 patients completed all aspects of the study: 22 patients (44 eyes) in the TES + SH group and 23 patients (46 eyes) in the SH group. There was no statistically significant difference in sex, age or course between the two groups. The mean OSDI scores, BUT, Schirmer's I test and corneal fluorescein scores exhibited a significant improvement in the TES + SH group compared with the SH group after treatment. No serious adverse events were recorded during TES treatment. In conclusion, TES combined with artificial tears appeared to be an effective treatment for DE. Therefore, TES may represent a new therapeutic option with promising potential applications.
Collapse
Affiliation(s)
- Ming-Ming Cai
- Department of Ophthalmology, The Ninth People's Hospital of Chongqing, Chongqing 400700, P.R. China
| | - Jie Zhang
- Department of Urology, The Ninth People's Hospital of Chongqing, Chongqing 400700, P.R. China
| |
Collapse
|
15
|
Schwarm FP, Ott M, Nagl J, Bender M, Stein M, Uhl E, Maxeiner H, Kolodziej MA. The Predictive Value of Transcutaneous Electrical Nerve Stimulation for Patient Selection in Peripheral Nerve Field Stimulation for Chronic Low Back Pain: A Prospective Study. Neuromodulation 2020; 24:1051-1058. [PMID: 32757257 DOI: 10.1111/ner.13244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/10/2020] [Accepted: 06/22/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Peripheral nerve field stimulation (PNFS) is an effective alternative treatment for patients with chronic low back pain. Transcutaneous electrical nerve stimulation (TENS) is frequently used in pain therapy. Aim of this prospective study was to examine the predictive value of TENS for later PNFS treatment. MATERIALS AND METHODS Between 2014 and 2019, a prospective cohort study of 41 patients with chronic lumbar pain was conducted. Pain intensity (NRS) was assessed before and after TENS use, preoperatively/postoperatively and in the follow-up after three and six months, SF12v2 questionnaires with physical (PCS) and mental component summary (MCS) scores, and Oswestry disability index (ODI) questionnaire at baseline as well as three and six months after PNFS implantation. Implantation of the PNFS-system with two percutaneous leads was performed after four to seven days of positive testing. Statistical analysis was performed using depending t-test, ANOVA, and Spearman correlation. RESULTS The cohort consisted of 41 patients (19 females, 22 males) with a median age of 60.5 years (IQR25-75 52-67). Two patients were lost to follow-up. After positive PNFS testing a pulse generator (IPG) was implanted in 15 patients with positive TENS effect and 15 patients without TENS effect. Leads were explanted in nine patients after negative PNFS trial phase. TENS positive patients showed significant correlation to a positive effect in the PNFS trial phase in NRS reduction (p = 0.042) indicating that TENS responders will also respond to PNFS (94% patients). After three and six months follow-up median NRS and SF12v2 (PCS) improved significantly in both cohorts, SF12v2 (MCS) and ODI only in the TENS positive cohort, respectively. CONCLUSION TENS can be predictive for patient selection in PNFS, as TENS positive patients showed significant correlation with a positive PNFS trial period. Therefore, TENS positive patients might be justifiable to be directly implanted with leads and IPG. TENS positive patients further tend to show a better improvement in the follow-up.
Collapse
Affiliation(s)
| | - Marc Ott
- Department of Neurosurgery, Justus-Liebig-University Giessen, Giessen, Germany
| | - Jasmin Nagl
- Department of Neurosurgery, Justus-Liebig-University Giessen, Giessen, Germany
| | - Michael Bender
- Department of Neurosurgery, Justus-Liebig-University Giessen, Giessen, Germany
| | - Marco Stein
- Department of Neurosurgery, Justus-Liebig-University Giessen, Giessen, Germany
| | - Eberhard Uhl
- Department of Neurosurgery, Justus-Liebig-University Giessen, Giessen, Germany
| | - Hagen Maxeiner
- Department of Anesthesiology, Intensive Care and Pain Therapy, Justus-Liebig-University Giessen, Giessen, Germany
| | | |
Collapse
|
16
|
Stabingas K, Bergman J, Patterson M, Tomycz ND. Peripheral subcutaneous field stimulation for the treatment of spinal cord injury at-level pain: case report, literature review, and 5-year follow-up. Heliyon 2020; 6:e04515. [PMID: 32743101 PMCID: PMC7385456 DOI: 10.1016/j.heliyon.2020.e04515] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 05/28/2020] [Accepted: 07/16/2020] [Indexed: 11/30/2022] Open
Abstract
Spinal cord injury (SCI) frequently engenders chronic pain which may be classified as occurring above, at, or below the level of injury. Since patients with SCI may have a complex combination of nociceptive and neuropathic pain, pharmacological interventions often fail. Peripheral subcutaneous field stimulation (PSFS) is a novel neuromodulation surgery for pain in which subcutaneous electrodes designed for spinal cord stimulation are placed subcutaneously in a region of pain. We report the case of a 26-year-old man who was an unrestrained driver in a motor vehicle accident and suffered a complete ASIA A spinal cord injury with paraplegia due to a T4 three-column burst fracture. He underwent successful surgical fixation of the fracture (7/27/12) and developed severe at-level SCI-associated pain which failed all conservative measures. After a successful trial, two octrode leads (Abbott Medical, Plano, TX, USA) were placed for PSFS under general anesthesia and were connected to a right flank rechargeable pulse generator (11/6/13). At 60 months postoperative, the patient continues to use the peripheral field stimulation system on a daily basis and reports near complete relief of his at-level spinal cord injury pain. He noted instantaneous relief of his pain once ideal stimulation programming was achieved and has tolerated complete cessation of all narcotic use. His current programming settings are: Frequency of 50 Hz (Hz), Pulse Width of 350 μs (μsec), Amplitude of 0.00 miliamps (mA), Comf of 7.70 mA, and Perc of 4.50 mA. Chronic pain is a challenging and expensive sequela to manage in SCI patients and newer therapies are needed. Our case suggests that SCI at-level pain may respond durably to PSFS and provides the longest published follow-up on a case of PSFS. Peripheral subcutaneous field stimulation remains an investigational treatment for chronic pain syndrome and larger, long-term follow up studies are needed for the FDA and payers to approve this modality.
Collapse
Affiliation(s)
- Kristen Stabingas
- Department of Neurosurgery, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA 15212, USA
| | - Jeffrey Bergman
- Department of Neurosurgery, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA 15212, USA
| | - Michael Patterson
- Center for Pain Relief, Allegheny Health Network, 161 Waterdam Road, McMurray, PA 15317, USA
| | - Nestor D Tomycz
- Department of Neurosurgery, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA 15212, USA
| |
Collapse
|
17
|
|
18
|
Strategies for interventional therapies in cancer-related pain-a crossroad in cancer pain management. Support Care Cancer 2019; 27:3133-3145. [PMID: 31093769 DOI: 10.1007/s00520-019-04827-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 04/23/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE Interventional therapies are important to consider when facing cancer pain refractory to conventional therapies. The objective of the current review is to introduce these effective strategies into dynamic interdisciplinary pain management, leading to an exhaustive approach to supportive oncology. METHODS Critical reflection based on literature analysis and clinical practice. RESULTS Interventional therapies act on the nervous system via neuromodulation or surgical approaches, or on primitive or metastatic lesions via interventional radiotherapy, percutaneous ablation, or surgery. Interventional therapies such as neuromodulations are constantly evolving with new technical works still in development. Nowadays, their usage is better defined, depending on clinical situations, and their impact on quality of life is proven. Nevertheless their availability and acceptability still need to be improved. To start with, a patient's interdisciplinary evaluation should cover a wide range of items such as patient's performance and psychological status, ethical considerations, and physiochemical and pharmacological properties of the cerebrospinal fluid for intrathecal neuromodulation. This will help to define the most appropriate strategy. In addition to determining the pros and cons of highly specialized interventional therapies, their relevance should be debated within interdisciplinary teams in order to select the best strategy for the right patient, at the right time. CONCLUSIONS Ultimately, the use of the interventional therapies can be limited by the requirement of specific trained healthcare teams and technical support, or the lack of health policies. However, these interventional strategies need to be proposed as soon as possible to each patient requiring them, as they can greatly improve quality of life.
Collapse
|
19
|
Feng B, Chen L, Ilham SJ. A review on ultrasonic neuromodulation of the peripheral nervous system: enhanced or suppressed activities? APPLIED SCIENCES-BASEL 2019; 9. [PMID: 34113463 PMCID: PMC8188893 DOI: 10.3390/app9081637] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Ultrasonic (US) neuromodulation has emerged as a promising therapeutic means by delivering focused energy deep into the tissue. Low-intensity ultrasound (US) directly activates and/or inhibits neurons in the central nervous system (CNS). US neuromodulation of the peripheral nervous system (PNS) is less developed and rarely used clinically. Literature on the neuromodulatory effects of US on the PNS is controversy with some documenting enhanced neural activities, some showing suppressed activities, and others reporting mixed effects. US, with different range of intensity and strength, is likely to generate distinct physical effects in the stimulated neuronal tissues, which underlies different experimental outcomes in the literature. In this review, we summarize all the major reports that documented the effects of US on peripheral nerve endings, axons, and/or somata in the dorsal root ganglion. In particular, we thoroughly discuss the potential impacts by the following key parameters to the study outcomes of PNS neuromodulation by the US: frequency, pulse repetition frequency, duty cycle, intensity, metrics for peripheral neural activities, and type of biological preparations used in the studies. Potential mechanisms of peripheral US neuromodulation are summarized to provide a plausible interpretation to the seemly contradictory effects of enhanced and suppressed neural activities from US neuromodulation.
Collapse
Affiliation(s)
- Bin Feng
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT, USA
- Correspondence: ; Tel.: (001-860-486-6435)
| | - Longtu Chen
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT, USA
| | - Sheikh J. Ilham
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT, USA
| |
Collapse
|
20
|
Deer TR, Jain S, Hunter C, Chakravarthy K. Neurostimulation for Intractable Chronic Pain. Brain Sci 2019; 9:E23. [PMID: 30682776 PMCID: PMC6406470 DOI: 10.3390/brainsci9020023] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/15/2019] [Accepted: 01/21/2019] [Indexed: 12/20/2022] Open
Abstract
The field of neuromodulation has seen unprecedented growth over the course of the last decade with novel waveforms, hardware advancements, and novel chronic pain indications. We present here an updated review on spinal cord stimulation, dorsal root ganglion stimulation, and peripheral nerve stimulation. We focus on mechanisms of action, clinical indications, and future areas of research. We also present current drawbacks with current stimulation technology and suggest areas of future advancements. Given the current shortage of viable treatment options using a pharmacological based approach and conservative interventional therapies, neuromodulation presents an interesting area of growth and development for the interventional pain field and provides current and future practitioners a fresh outlook with regards to its place in the chronic pain treatment paradigm.
Collapse
Affiliation(s)
- Timothy R Deer
- Spine and Nerve Center of the Virginias, Charleston, VA 25301, USA.
| | - Sameer Jain
- Pain Treatment Centers of America, Little Rock, AR 72205, USA.
| | - Corey Hunter
- Ainsworth Institute of Pain Management, New York, NY 10022, USA.
| | - Krishnan Chakravarthy
- Department of Anesthesiology and Pain Medicine, University of California San Diego Health Sciences, San Diego, CA 92037, USA.
| |
Collapse
|
21
|
Schwarm FP, Stein M, Uhl E, Maxeiner H, Kolodziej MA. A Retrospective Analysis of 25 Cases With Peripheral Nerve Field Stimulation for Chronic Low Back Pain and the Predictive Value of Transcutaneous Electrical Nerve Stimulation for Patient Selection. Neuromodulation 2018; 22:607-614. [DOI: 10.1111/ner.12890] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 10/02/2018] [Accepted: 10/18/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Frank P. Schwarm
- Department of NeurosurgeryJustus‐Liebig‐University Giessen Giessen Germany
| | - Marco Stein
- Department of NeurosurgeryJustus‐Liebig‐University Giessen Giessen Germany
| | - Eberhard Uhl
- Department of NeurosurgeryJustus‐Liebig‐University Giessen Giessen Germany
| | - Hagen Maxeiner
- Department of AnesthesiologyIntensive Care and Pain Therapy, Justus‐Liebig‐University Giessen Giessen Germany
| | | |
Collapse
|
22
|
Sridharan A, Chirania S, Towe BC, Muthuswamy J. Remote Stimulation of Sciatic Nerve Using Cuff Electrodes and Implanted Diodes. MICROMACHINES 2018; 9:mi9110595. [PMID: 30441831 PMCID: PMC6266837 DOI: 10.3390/mi9110595] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/05/2018] [Accepted: 11/12/2018] [Indexed: 12/23/2022]
Abstract
We demonstrate a method of neurostimulation using implanted, free-floating, inter-neural diodes. They are activated by volume-conducted, high frequency, alternating current (AC) fields and address the issue of instability caused by interconnect wires in chronic nerve stimulation. The aim of this study is to optimize the set of AC electrical parameters and the diode features to achieve wireless neurostimulation. Three different packaged Schottky diodes (1.5 mm, 500 µm and 220 µm feature sizes) were tested in vivo (n = 17 rats). A careful assessment of sciatic nerve activation as a function of diode–dipole lengths and relative position of the diode was conducted. Subsequently, free-floating Schottky microdiodes were implanted in the nerve (n = 3 rats) and stimulated wirelessly. Thresholds for muscle twitch responses increased non-linearly with frequency. Currents through implanted diodes within the nerve suffer large attenuations (~100 fold) requiring 1–2 mA drive currents for thresholds at 17 µA. The muscle recruitment response using electromyograms (EMGs) is intrinsically steep for subepineurial implants and becomes steeper as diode is implanted at increasing depths away from external AC stimulating electrodes. The study demonstrates the feasibility of activating remote, untethered, implanted microscale diodes using external AC fields and achieving neurostimulation.
Collapse
Affiliation(s)
- Arati Sridharan
- School of Biological & Health Systems Engineering, Ira A. Fulton School of Engineering, Arizona State University, Tempe, AZ 85287, USA.
| | - Sanchit Chirania
- School of Biological & Health Systems Engineering, Ira A. Fulton School of Engineering, Arizona State University, Tempe, AZ 85287, USA.
| | - Bruce C Towe
- School of Biological & Health Systems Engineering, Ira A. Fulton School of Engineering, Arizona State University, Tempe, AZ 85287, USA.
| | - Jit Muthuswamy
- School of Biological & Health Systems Engineering, Ira A. Fulton School of Engineering, Arizona State University, Tempe, AZ 85287, USA.
| |
Collapse
|
23
|
Median nerve stimulation induces analgesia via orexin-initiated endocannabinoid disinhibition in the periaqueductal gray. Proc Natl Acad Sci U S A 2018; 115:E10720-E10729. [PMID: 30348772 DOI: 10.1073/pnas.1807991115] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Adequate pain management remains an unmet medical need. We previously revealed an opioid-independent analgesic mechanism mediated by orexin 1 receptor (OX1R)-initiated 2-arachidonoylglycerol (2-AG) signaling in the ventrolateral periaqueductal gray (vlPAG). Here, we found that low-frequency median nerve stimulation (MNS) through acupuncture needles at the PC6 (Neiguan) acupoint (MNS-PC6) induced an antinociceptive effect that engaged this mechanism. In mice, MNS-PC6 reduced acute thermal nociceptive responses and neuropathy-induced mechanical allodynia, increased the number of c-Fos-immunoreactive hypothalamic orexin neurons, and led to higher orexin A and lower GABA levels in the vlPAG. Such responses were not seen in mice with PC6 needle insertion only or electrical stimulation of the lateral deltoid, a nonmedian nerve-innervated location. Directly stimulating the surgically exposed median nerve also increased vlPAG orexin A levels. MNS-PC6-induced antinociception (MNS-PC6-IA) was prevented by proximal block of the median nerve with lidocaine as well as by systemic or intravlPAG injection of an antagonist of OX1Rs or cannabinoid 1 receptors (CB1Rs) but not by opioid receptor antagonists. Systemic blockade of OX1Rs or CB1Rs also restored vlPAG GABA levels after MNS-PC6. A cannabinoid (2-AG)-dependent mechanism was also implicated by the observations that MNS-PC6-IA was prevented by intravlPAG inhibition of 2-AG synthesis and was attenuated in Cnr1 -/- mice. These findings suggest that PC6-targeting low-frequency MNS activates hypothalamic orexin neurons, releasing orexins to induce analgesia through a CB1R-dependent cascade mediated by OX1R-initiated 2-AG retrograde disinhibition in the vlPAG. The opioid-independent characteristic of MNS-PC6-induced analgesia may provide a strategy for pain management in opioid-tolerant patients.
Collapse
|
24
|
McAdams I, Kenyon H, Bourbeau D, Damaser MS, Zorman C, Majerus SJA. Low-cost, Implantable Wireless Sensor Platform for Neuromodulation Research. IEEE BIOMEDICAL CIRCUITS AND SYSTEMS CONFERENCE : HEALTHCARE TECHNOLOGY : [PROCEEDINGS]. IEEE BIOMEDICAL CIRCUITS AND SYSTEMS CONFERENCE 2018; 2018:10.1109/BIOCAS.2018.8584729. [PMID: 32064467 PMCID: PMC7020620 DOI: 10.1109/biocas.2018.8584729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The role of peripheral nerves in regulating major organ function in health and disease is not well understood. Elucidating the relationships between biomarkers and neural activity during conditions free form anesthesia is essential to advancing future investigations of autonomic organ control and improving precision for neuromodulation treatment approaches. Here we present a simple, customizable, off-the-shelf component sensor platform to meet research needs for studying different organs under conscious, free movement. The platform consists of a small, rechargeable coin-cell battery, an energy-harvesting IC, a low-power microcontroller, a low-power pressure transducer, customizable number of electrodes with a common anode, inductive recharge input, and OOK inductive transmission. A case study demonstrating a bladder implant for long-term monitoring is presented, utilizing a novel, non-hermetic encapsulation approach. The customized platform uses two sleep modes to minimize battery loading, exhibiting a maximum time-averaged current draw of 125 micro-amps during sensing and transmission, with a quiescent current draw of 95 nano-amps into the microcontroller.
Collapse
Affiliation(s)
- Ian McAdams
- Dept. of Biomedical Engineering, Lerner Research Institute
- Dept. of Electrical Engineering and Computer Science Case Western Reserve University Cleveland, Ohio, USA
| | - Hannah Kenyon
- Dept. of Biomedical Engineering, Lerner Research Institute
| | | | - Margot S Damaser
- Dept. of Biomedical Engineering, Lerner Research Institute
- Glickman Urological and Kidney Institute Cleveland Clinic
- Advanced Platform Technology Center Louis Stokes Veterans Affairs Medical Center Cleveland, Ohio, USA
| | - Christian Zorman
- Dept. of Biomedical Engineering, Lerner Research Institute
- Dept. of Electrical Engineering and Computer Science Case Western Reserve University Cleveland, Ohio, USA
- Glickman Urological and Kidney Institute Cleveland Clinic
| | - Steve J A Majerus
- Dept. of Biomedical Engineering, Lerner Research Institute
- Advanced Platform Technology Center Louis Stokes Veterans Affairs Medical Center Cleveland, Ohio, USA
| |
Collapse
|
25
|
Goroszeniuk T. The Effect of Peripheral Neuromodulation on Pain From the Sacroiliac Joint: A Retrospective Cohort Study. Neuromodulation 2018; 22:661-666. [PMID: 30238573 DOI: 10.1111/ner.12803] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 04/10/2018] [Accepted: 04/23/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To report a retrospective review of the longer-term results of peripheral neuromodulation in 12 patients with significant chronic sacroiliac joint pain who had previously failed multiple conservative and interventional pain therapies. METHODS To allow for the assessment of meaningful longer-term outcome, implants for all 12 patients had been in place for a minimum of 18 months to a maximum of 36 months prior to the formal review. RESULTS Compared to the preimplantation baseline, the longer-term follow-up revealed a significant and sustained reduction in visual analog scale pain scores from 8.7T 1.1 to 1.1T 1.0 (p < 0.001), with a 75% reduction in analgesia requirement, and improvement in pain impact on daily function from 94.1% T 5.9% to 5.8% T 6.0% (p < 0.001). CONCLUSION This initial case series has highlighted that SIJ neuromodulation results in the reduction in pain intensity and improved functionality in patients who have already failed conventional medical management and interventional techniques, including RF denervation. These preliminary results merit a prospective randomized trial of peripheral neuromodulation.
Collapse
|
26
|
Duncan CC, Kluger DT, Davis TS, Warren DJ, Page DM, Hutchinson DT, Clark GA. Selective Decrease in Allodynia With High‐Frequency Neuromodulation via High‐Electrode‐Count Intrafascicular Peripheral Nerve Interface After Brachial Plexus Injury. Neuromodulation 2018; 22:597-606. [DOI: 10.1111/ner.12802] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/18/2018] [Accepted: 05/15/2018] [Indexed: 11/29/2022]
Affiliation(s)
| | - David T. Kluger
- Department of Bioengineering University of Utah Salt Lake City UT USA
| | - Tyler S. Davis
- Department of Bioengineering University of Utah Salt Lake City UT USA
| | - David J. Warren
- Department of Bioengineering University of Utah Salt Lake City UT USA
| | - David M. Page
- Department of Bioengineering University of Utah Salt Lake City UT USA
| | | | - Gregory A. Clark
- Department of Bioengineering University of Utah Salt Lake City UT USA
| |
Collapse
|
27
|
Mercante B, Ginatempo F, Manca A, Melis F, Enrico P, Deriu F. Anatomo-Physiologic Basis for Auricular Stimulation. Med Acupunct 2018; 30:141-150. [PMID: 29937968 DOI: 10.1089/acu.2017.1254] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Introduction: Stimulation of cranial nerves modulates central nervous system (CNS) activity via the extensive connections of their brainstem nuclei to higher-order structures. Clinical experience with vagus-nerve stimulation (VNS) demonstrates that it produces robust therapeutic effects, however, posing concerns related to its invasiveness and side-effects. Discussion: Trigeminal nerve stimulation (TNS) has been recently proposed as a valid alternative to VNS. The ear presents afferent vagus and trigeminal-nerve distribution; its innervation is the theoretical basis of different reflex therapies, including auriculotherapy. An increasing number of studies have shown that several therapeutic effects induced by invasive VNS and TNS, can be reproduced by noninvasive auricular-nerve stimulation. However, the sites and neurobiologic mechanisms by which VNS and TNS produce their therapeutic effects are not clear yet. Conclusions: Accumulating evidence suggests that VNS and TNS share multiple levels and mechanisms of action in the CNS.
Collapse
Affiliation(s)
- Beniamina Mercante
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43/b, 07100 Sassari Italy
| | - Francesca Ginatempo
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43/b, 07100 Sassari Italy
| | - Andrea Manca
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43/b, 07100 Sassari Italy
| | - Francesco Melis
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43/b, 07100 Sassari Italy
| | - Paolo Enrico
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43/b, 07100 Sassari Italy
| | - Franca Deriu
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43/b, 07100 Sassari Italy
| |
Collapse
|
28
|
Mercante B, Deriu F, Rangon CM. Auricular Neuromodulation: The Emerging Concept beyond the Stimulation of Vagus and Trigeminal Nerves. MEDICINES 2018; 5:medicines5010010. [PMID: 29361732 PMCID: PMC5874575 DOI: 10.3390/medicines5010010] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 01/12/2018] [Accepted: 01/19/2018] [Indexed: 12/16/2022]
Abstract
Neuromodulation, thanks to intrinsic and extrinsic brain feedback loops, seems to be the best way to exploit brain plasticity for therapeutic purposes. In the past years, there has been tremendous advances in the field of non-pharmacological modulation of brain activity. This review of different neurostimulation techniques will focus on sites and mechanisms of both transcutaneous vagus and trigeminal nerve stimulation. These methods are scientifically validated non-invasive bottom-up brain modulation techniques, easily implemented from the outer ear. In the light of this, auricles could transpire to be the most affordable target for non-invasive manipulation of central nervous system functions.
Collapse
Affiliation(s)
- Beniamina Mercante
- Department of Biomedical Sciences, University of Sassari, Sassari 07100, Italy.
| | - Franca Deriu
- Department of Biomedical Sciences, University of Sassari, Sassari 07100, Italy.
| | - Claire-Marie Rangon
- Head of Scientific Auriculotherapy Diploma, Faculty of Medicine, University of Paris-Saclay, Saclay 94270, France.
| |
Collapse
|
29
|
Slavin KV, Yin D, Rasskazoff S. Peripheral Nerve Stimulation for Facial Pain. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00058-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
30
|
Neuromodulation for Treatment of Dry Eye. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00102-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
31
|
Migraine Prevention Using Different Frequencies of Transcutaneous Occipital Nerve Stimulation: A Randomized Controlled Trial. THE JOURNAL OF PAIN 2017; 18:1006-1015. [DOI: 10.1016/j.jpain.2017.03.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 03/10/2017] [Accepted: 03/27/2017] [Indexed: 01/03/2023]
|
32
|
Chen L, Ilham SJ, Guo T, Emadi S, Feng B. In vitro multichannel single-unit recordings of action potentials from mouse sciatic nerve. Biomed Phys Eng Express 2017; 3:045020. [PMID: 29568573 PMCID: PMC5858727 DOI: 10.1088/2057-1976/aa7efa] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Electrode arrays interfacing with peripheral nerves are essential for neuromodulation devices targeting peripheral organs to relieve symptoms. To modulate (i.e., single-unit recording and stimulating) individual peripheral nerve axons remains a technical challenge. Here, we report an in vitro setup to allow simultaneous single-unit recordings from multiple mouse sciatic nerve axons. The sciatic nerve (~30 mm) was harvested and transferred to a tissue chamber, the ~5mm distal end pulled into an adjacent recording chamber filled with paraffin oil. A custom-built multi-wire electrode array was used to interface with split fine nerve filaments. Single-unit action potentials were evoked by electrical stimulation and recorded from 186 axons, of which 49.5% were classed A-type with conduction velocities (CV) greater than 1 m/s and 50.5% were C-type (CV < 1 m/s). The single-unit recordings had no apparent bias towards A- or C-type axons, were robust and repeatable for over 60 minutes, and thus an ideal opportunity to assess different neuromodulation strategies targeting peripheral nerves. For instance, ultrasonic modulation of action potential transmission was assessed using the setup, indicating increased nerve conduction velocity following ultrasound stimulus. This setup can also be used to objectively assess the design of next-generation electrode arrays interfacing with peripheral nerves.
Collapse
Affiliation(s)
- L Chen
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
| | - S J Ilham
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
| | - T Guo
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
| | - S Emadi
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
| | - B Feng
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
| |
Collapse
|
33
|
Abstract
Cancer pain remains a significant clinical problem worldwide. Causes of cancer pain are multifactorial and complex and are likely to vary with an array of tumor-related and host-related factors and processes. Pathophysiology is poorly understood; however, new laboratory research points to cross-talk between cancer cells and host’s immune and neural systems as an important potential mechanism that may be broadly relevant to many cancer pain syndromes. Opioids remain the most effective pharmaceuticals used in the treatment of cancer pain. However, their role has been evolving due to emerging awareness of risks of chronic opioid therapy. Despite extensive research efforts, no new class of analgesics has been developed. However, many potential therapeutic targets that may lead to the establishment of new pharmaceuticals have been identified in recent years. It is also expected that the role of non-pharmacological modalities of treatment will grow in prominence. Specifically, neuromodulation, a rapidly expanding field, may play a major role in the treatment of neuropathic cancer pain provided that further technological progress permits the development of non-invasive and inexpensive neuromodulation techniques.
Collapse
Affiliation(s)
- Marcin Chwistek
- Department of Hematology and Medical Oncology, Fox Chase Cancer Center/Temple Health, Philadelphia, PA, USA
| |
Collapse
|
34
|
Abstract
Chronic neuropathic pain is a widespread problem with negative personal and societal consequences. Despite considerable clinical neuroscience research, the goal of developing effective, reliable, and durable treatments has remained elusive. The critical role played by the dorsal root ganglion (DRG) in the induction and maintenance of chronic pain has been largely overlooked in these efforts, however. It may be that, by targeting this site, robust new options for pain management will be revealed. This review summarizes recent advances in the knowledge base for DRG-targeted treatments for neuropathic pain:• Pharmacological options including the chemical targeting of voltage-dependent calcium channels, transient receptor potential channels, neurotrophin production, potentiation of opioid transduction pathways, and excitatory glutamate receptors.• Ablation or modulation of the DRG via continuous thermal radiofrequency and pulsed radiofrequency treatments.• Implanted electrical neurostimulator technologies.• Interventions involving the modification of DRG cellular function at the genetic level by using viral vectors and gene silencing methods.
Collapse
|
35
|
Goroszeniuk T, Shetty A, Munglani R, Hegarty D, Bhaskar A. The Effect of Peripheral Neuromodulation on Pain from the Sacroiliac Joint: A Retrospective Cohort Study. Pain Pract 2017; 17:982-982. [PMID: 28226403 DOI: 10.1111/papr.12567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 01/08/2017] [Accepted: 01/13/2017] [Indexed: 11/28/2022]
Abstract
We report here a retrospective review of the longer-term results of peripheral neuromodulation in 12 patients with significant chronic sacroiliac joint pain who had previously failed multiple conservative and interventional pain therapies. To allow for the assessment of meaningful longer-term outcome, implants for all 12 patients had been in place for a minimum of 18 months to a maximum of 36 months prior to the formal review. Compared to the preimplantation baseline, the longer-term follow-up revealed a significant and sustained reduction in visual analog scale pain scores from 8.7 ± 1.1 to 1.1 ± 1.0 (P < 0.001), with a 75% reduction in analgesia requirement, and improvement in pain impact on daily function from 94.1% ± 5.9% to 5.8% ± 6.0% (P < 0.001). These preliminary results merit a prospective randomized trial of peripheral neuromodulation.
Collapse
Affiliation(s)
| | - Ashish Shetty
- National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, U.K
| | - Rajesh Munglani
- Pain Management, Guys and St. Thomas' NHS Foundation Trust, London, U.K
| | - Dominic Hegarty
- Pain Management, Guys and St. Thomas' NHS Foundation Trust, London, U.K
- Department of Anaesthesia and Pain Medicine, Cork University Hospital, Wilton, Cork, Ireland
| | | |
Collapse
|
36
|
Chakravarthy K, Nava A, Christo PJ, Williams K. Review of Recent Advances in Peripheral Nerve Stimulation (PNS). Curr Pain Headache Rep 2017; 20:60. [PMID: 27671799 DOI: 10.1007/s11916-016-0590-8] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Peripheral nerve stimulation (PNS) for the treatment of chronic pain has become an increasingly important field in the arena of neuromodulation, given the ongoing advances in electrical neuromodulation technology since 1999 permitting minimally invasive approaches using an percutaneous approach as opposed to implantable systems. Our review aims to provide clinicians with the recent advances and studies in the field, with specific emphasis on clinical data and indications that have been accumulated over the last several years. In addition, we aim to address key basic science studies to further emphasize the importance of translational research outcomes driving clinical management.
Collapse
Affiliation(s)
- Krishnan Chakravarthy
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, Boston, 02114, MA, USA.
| | - Andrew Nava
- Department of Anesthesiology and Critical Care Medicine, Division of Pain Medicine, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, 21287, MD, USA.,Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Paul J Christo
- Department of Anesthesiology and Critical Care Medicine, Division of Pain Medicine, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, 21287, MD, USA
| | - Kayode Williams
- Department of Anesthesiology and Critical Care Medicine, Division of Pain Medicine, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, 21287, MD, USA
| |
Collapse
|
37
|
Sahyouni R, Chang DT, Moshtaghi O, Mahmoodi A, Djalilian HR, Lin HW. Functional and Histological Effects of Chronic Neural Electrode Implantation. Laryngoscope Investig Otolaryngol 2017; 2:80-93. [PMID: 28894826 PMCID: PMC5527370 DOI: 10.1002/lio2.66] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2016] [Indexed: 12/27/2022] Open
Abstract
Objectives Permanent injury to the cranial nerves can often result in a substantial reduction in quality of life. Novel and innovative interventions can help restore form and function in nerve paralysis, with bioelectric interfaces among the more promising of these approaches. The foreign body response is an important consideration for any bioelectric device as it influences the function and effectiveness of the implant. The purpose of this review is to describe tissue and functional effects of chronic neural implantation among the different categories of neural implants and highlight advances in peripheral and cranial nerve stimulation. Data Sources: PubMed, IEEE, and Web of Science literature search. Review Methods: A review of the current literature was conducted to examine functional and histologic effects of bioelectric interfaces for neural implants. Results Bioelectric devices can be characterized as intraneural, epineural, perineural, intranuclear, or cortical depending on their placement relative to nerves and neuronal cell bodies. Such devices include nerve‐specific stimulators, neuroprosthetics, brainstem implants, and deep brain stimulators. Regardless of electrode location and interface type, acute and chronic histological, macroscopic and functional changes can occur as a result of both passive and active tissue responses to the bioelectric implant. Conclusion A variety of chronically implantable electrodes have been developed to treat disorders of the peripheral and cranial nerves, to varying degrees of efficacy. Consideration and mitigation of detrimental effects at the neural interface with further optimization of functional nerve stimulation will facilitate the development of these technologies and translation to the clinic. Level of Evidence 3.
Collapse
Affiliation(s)
- Ronald Sahyouni
- Department of Biomedical Engineering, University of California Irvine U.S.A
| | - David T Chang
- Department of Otolaryngology-Head & Neck Surgery, University of California Irvine U.S.A.,Division of Otolaryngology-Head &Neck Surgery, Irvine, California, Children's Hospital of Orange County Orange California U.S.A
| | - Omid Moshtaghi
- School of Medicine, University of California Irvine U.S.A
| | - Amin Mahmoodi
- Department of Biomedical Engineering, University of California Irvine U.S.A
| | - Hamid R Djalilian
- Department of Otolaryngology-Head & Neck Surgery, University of California Irvine U.S.A
| | - Harrison W Lin
- Department of Otolaryngology-Head & Neck Surgery, University of California Irvine U.S.A
| |
Collapse
|
38
|
McRoberts WP. Optimizing Stimulation in a Case of Facial Pain Through "Cross-Talk" of Peripheral and Central Leads: A Case Report. Neuromodulation 2016; 19:885-888. [PMID: 27191684 DOI: 10.1111/ner.12443] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 03/03/2016] [Accepted: 03/10/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To describe inter-lead (cross-talk) stimulation between a trigeminal nerve lead and a cervical epidural lead for the treatment of facial pain in a 69-year-old patient with empty nose syndrome. MATERIALS AND METHODS A trial implant was performed with a peripheral V2 trigeminal lead and a C1-C2 lead in cross-talk configuration. During permanent implant, the V2 lead was placed uneventfully while the central lead could only be advanced to C3-C4. RESULTS During the trial, pain decreased by 70%. One month after permanent implant, the patient still experienced a 60-70% reduction in pain levels and a decrease from ten to two weekly pain episodes. Nine months post implant, the patient reported complete pain relief (0/10 on a numeric rating scale ranging from 0 to 10) and medications were discontinued. Infrequent exacerbations (3/10) were controlled by increasing stimulation. Three years post implant, the patient continued to have no baseline pain and could easily control exacerbations. CONCLUSION Cross-talk configuration between a peripheral and a central lead created a more efficient stimulation technique. The resulting paresthesia was superior to that obtained from either lead alone and exceeded the paresthesia obtained from the combination of the two leads when used simultaneously, without an inter-lead configuration.
Collapse
|
39
|
Friedman NJ, Butron K, Robledo N, Loudin J, Baba SN, Chayet A. A nonrandomized, open-label study to evaluate the effect of nasal stimulation on tear production in subjects with dry eye disease. Clin Ophthalmol 2016; 10:795-804. [PMID: 27217719 PMCID: PMC4862385 DOI: 10.2147/opth.s101716] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Dry eye disease (DED), a chronic disorder affecting the tear film and lacrimal functional unit, is a widely prevalent condition associated with significant burden and unmet treatment needs. Since specific neural circuits play an important role in maintaining ocular surface health, microelectrical stimulation of these pathways could present a promising new approach to treating DED. This study evaluated the efficacy and safety of nasal electrical stimulation in patients with DED. Methods This prospective, open-label, single-arm, nonrandomized pilot study included 40 patients with mild to severe DED. After undergoing two screening visits, enrolled subjects were provided with a nasal stimulation device and instructed to use it at home four times daily (or more often as needed). Follow-up assessments were conducted up to day 180. The primary efficacy endpoint was the difference between unstimulated and stimulated tear production quantified by Schirmer scores. Additional efficacy endpoints included change from baseline in corneal and conjunctival staining, symptoms evaluated on a Visual Analog Scale, and Ocular Surface Disease Index scores. Safety parameters included adverse event (AE) rates, visual acuity, intraocular pressure, slit-lamp biomicroscopy, indirect ophthalmoscopy, and endoscopic nasal examinations. Results Mean stimulated Schirmer scores were significantly higher than the unstimulated scores at all visits, and corneal and conjunctival staining and symptom scores from baseline to day 180 were significantly reduced. No serious device-related AEs and nine nonserious AEs (three device-related) were reported. Intraocular pressure remained stable and most subjects showed little or no change in visual acuity at days 30 and 180. No significant findings from other clinical examinations were noted. Conclusion Neurostimulation of the nasolacrimal pathway is a safe and effective means of increasing tear production and reducing symptoms of dry eye in patients with DED.
Collapse
Affiliation(s)
- Neil J Friedman
- Department of Ophthalmology, Stanford University, Mid-Peninsula Ophthalmology Medical Group, Palo Alto, CA, USA
| | | | | | | | | | | |
Collapse
|
40
|
Calabrò RS, Nibali VC, Naro A, Floridia D, Pizzimenti M, Salmeri L, Salviera C, Bramanti P. Is non-invasive neuromuscular electrical stimulation effective in severe chronic neurogenic dysphagia? Reporton a post-traumatic brain injury patient. NeuroRehabilitation 2016; 38:53-7. [DOI: 10.3233/nre-151295] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | - Antonino Naro
- IRCCS Centro Neurolesi “Bonino-Pulejo” Messina, Messina, Italy
| | | | | | - Lucia Salmeri
- IRCCS Centro Neurolesi “Bonino-Pulejo” Messina, Messina, Italy
| | - Carlo Salviera
- Department of Otorinolaringoiatry, University of Messina, Messina, Italy
| | | |
Collapse
|
41
|
Thompson BC, Murray E, Wallace GG. Graphite Oxide to Graphene. Biomaterials to Bionics. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2015; 27:7563-7582. [PMID: 25914294 DOI: 10.1002/adma.201500411] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/04/2015] [Indexed: 06/04/2023]
Abstract
The advent of implantable biomaterials has revolutionized medical treatment, allowing the development of the fields of tissue engineering and medical bionic devices (e.g., cochlea implants to restore hearing, vagus nerve stimulators to control Parkinson's disease, and cardiac pace makers). Similarly, future materials developments are likely to continue to drive development in treatment of disease and disability, or even enhancing human potential. The material requirements for implantable devices are stringent. In all cases they must be nontoxic and provide appropriate mechanical integrity for the application at hand. In the case of scaffolds for tissue regeneration, biodegradability in an appropriate time frame may be required, and for medical bionics electronic conductivity is essential. The emergence of graphene and graphene-family composites has resulted in materials and structures highly relevant to the expansion of the biomaterials inventory available for implantable medical devices. The rich chemistries available are able to ensure properties uncovered in the nanodomain are conveyed into the world of macroscopic devices. Here, the inherent properties of graphene, along with how graphene or structures containing it interface with living cells and the effect of electrical stimulation on nerves and cells, are reviewed.
Collapse
Affiliation(s)
- Brianna C Thompson
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 639798, Singapore
| | - Eoin Murray
- Institute for Sports Research, Nanyang Technological University, 639798, Singapore
| | - Gordon G Wallace
- Intelligent Polymer Research Institute, ARC Center of Excellence for Electromaterials Science, University of Wollongong, 2500, Australia
| |
Collapse
|
42
|
Pessoa BL, Escudeiro G, Nascimento OJM. Emerging Treatments for Neuropathic Pain. Curr Pain Headache Rep 2015; 19:56. [DOI: 10.1007/s11916-015-0530-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
43
|
Chronic multichannel neural recordings from soft regenerative microchannel electrodes during gait. Sci Rep 2015; 5:14363. [PMID: 26400791 PMCID: PMC4585830 DOI: 10.1038/srep14363] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 08/24/2015] [Indexed: 11/24/2022] Open
Abstract
Reliably interfacing a nerve with an electrode array is one of the approaches to restore motor and sensory functions after an injury to the peripheral nerve. Accomplishing this with current technologies is challenging as the electrode-neuron interface often degrades over time, and surrounding myoelectric signals contaminate the neuro-signals in awake, moving animals. The purpose of this study was to evaluate the potential of microchannel electrode implants to monitor over time and in freely moving animals, neural activity from regenerating nerves. We designed and fabricated implants with silicone rubber and elastic thin-film metallization. Each implant carries an eight-by-twelve matrix of parallel microchannels (of 120 × 110 μm2 cross-section and 4 mm length) and gold thin-film electrodes embedded in the floor of ten of the microchannels. After sterilization, the soft, multi-lumen electrode implant is sutured between the stumps of the sciatic nerve. Over a period of three months and in four rats, the microchannel electrodes recorded spike activity from the regenerating sciatic nerve. Histology indicates mini-nerves formed of axons and supporting cells regenerate robustly in the implants. Analysis of the recorded spikes and gait kinematics over the ten-week period suggests firing patterns collected with the microchannel electrode implant can be associated with different phases of gait.
Collapse
|
44
|
Castel-Lacanal E. Sites of electrical stimulation used in neurology. Ann Phys Rehabil Med 2015; 58:201-207. [PMID: 26183200 DOI: 10.1016/j.rehab.2015.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 05/28/2015] [Accepted: 05/28/2015] [Indexed: 11/29/2022]
Abstract
Rehabilitation aims to decrease neurological impairments, in guiding plasticity. Electrical stimulation has been used for many years in rehabilitation treatment of neurological disabilities as a tool for neuromodulation inducing plasticity, although the mechanisms of its action are not well known. The applications vary, encompassing therapeutic and rehabilitative aims. The type and site of stimulation vary depending on the objectives. Some techniques are widely used in clinical practice; others are still in the research stage. They may be invasive, epidural or in direct contact with neurons; they may be noninvasive, applied transcutaneously or indirectly by current vectors. The indications vary: mobility, functionality, pain as well as pharyngeal, respiratory, and perineal function. This paper aims to summarize current data on electrical neuromodulation techniques used in neurorehabilitation, their effects and their mechanisms of action.
Collapse
Affiliation(s)
- E Castel-Lacanal
- Inserm U 825, CHU Purpan, Pavillon Baudot, place du Dr-Baylac, 31024 Toulouse cedex 3, France; Service de Médecine Physique et Réadaptation, CHU Rangueil, 1, avenue Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France.
| |
Collapse
|
45
|
Omolehinwa TT, Musbah T, Desai B, O'Malley BW, Stoopler ET. Neuralgia associated with transcutaneous electrical nerve stimulation therapy in a patient initially diagnosed with temporomandibular disorder. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 119:e101-4. [PMID: 25660829 DOI: 10.1016/j.oooo.2014.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 12/09/2014] [Accepted: 12/18/2014] [Indexed: 10/24/2022]
Abstract
Head and neck neoplasms may be difficult to detect because of wide-ranging symptoms and the presence of overlapping anatomic structures in the region. This case report describes a patient with chronic otalgia and temporomandibular disorder, who developed sudden-onset neuralgia while receiving transcutaneous electrical nerve stimulation (TENS) therapy. Further diagnostic evaluation revealed a skull base tumor consistent with adenoid cystic carcinoma. To our knowledge, this is the first report of TENS-associated neuralgia leading to a diagnosis of primary intracranial adenoid cystic carcinoma.
Collapse
Affiliation(s)
- Temitope T Omolehinwa
- Postdoctoral Fellow, Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, USA
| | - Thamer Musbah
- First year resident, Orofacial Pain program, University of Kentucky College of Dentistry, Lexington, Kentucky, USA
| | - Bhavik Desai
- Assistant Professor of Oral Medicine, Department of Oral and Maxillofacial Surgery, Virginia Commonwealth University School of Dentistry, Richmond, Virginia, USA
| | - Bert W O'Malley
- Gabriel Tucker Professor and Chair, Department of Otorhinolaryngology: Head and Neck Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Eric T Stoopler
- Associate Professor of Oral Medicine, Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, USA.
| |
Collapse
|
46
|
Abstract
Peripheral nerve stimulation and peripheral nerve field stimulation involve the delivery of electrical stimulation using implanted electrodes either over a target nerve or over the painful area with the goal of modulating neuropathic pain. The selection of appropriate candidates for this therapy hinges on skillful application of inclusion and exclusion criteria, psychological screening, and an invasive screening trial. Patients with significant improvement in pain severity and pain-related disability during the trial are considered candidates for implantation of a permanent system. As with other implanted devices for neuromodulation, risks of mechanical failures, infection, and neurologic complications exist.
Collapse
Affiliation(s)
- Erika A Petersen
- Department of Neurosurgery, University of Arkansas for Medical Sciences, 4301 West Markham, Slot 507, Little Rock, AR 72205, USA
| | - Konstantin V Slavin
- Department of Neurosurgery, University of Illinois at Chicago, M/C 799, 912 South Wood Street, Chicago, IL 60612, USA.
| |
Collapse
|