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Fishman MA, Chitneni A, Abd-Elsayed A, Grodofsky S, Scherer AM, Schetzner B, Klusek M, Popielarski SR, Meloni S, Falowski S, Kim P, Slavin KV, Silberstein SD. Drug-Free Noninvasive Thermal Nerve Block: Validation of Sham Devices. Brain Sci 2023; 13:1718. [PMID: 38137166 PMCID: PMC10741966 DOI: 10.3390/brainsci13121718] [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: 10/12/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
Headache is a leading cause of disability and suffering. One major challenge in developing device treatments is demonstrating their efficacy given devices' often-high placebo rate. This paper reviews the importance of validating sham devices as part of finalizing the design for larger-scale prospective randomized controlled trials in patients with chronic headache as well as the results of a prospective, single-blind trial to validate two potential sham noninvasive thermal nerve block devices. Study participants were trained to self-administer thermal nerve block treatment using sham devices in an office visit. Two different sham systems with different temperature profiles were assessed. Devices were offered for patients to use daily at-home for one week to assess the durability of sham placebo effects before participants were given active treatment in a second office visit followed by another optional week of self-administered active treatment at-home use. Sham treatments reduced pain scores by an average of 31% from 6.0 ± 2.3 to 4.3 ± 3.3, including two participants who fell asleep during the in-office treatment and woke up with no pain, but whose pain recurred after returning home during at-home use of the sham system. In-office active treatments reduced pain scores by 52% from 6.7 ± 2.1 to 3.3 ± 2.9 with sustained pain relief during optional at-home use. Successful blinding for the study was confirmed with an ideal Bang's Blinding Index of 0 and an ideal James' Blinding Index of 1. Both the sham and active treatments were viewed by participants as highly credible, and credibility increased from the beginning to end of sham treatments on average.
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Affiliation(s)
- Michael A. Fishman
- Center for Pain Control PC, Lancaster, PA 19610, USA; (M.A.F.); (A.M.S.)
| | - Ahish Chitneni
- Department of Rehabilitation and Regenerative Medicine, New York-Presbyterian Hospital—Columbia and Cornell, New York, NY 10065, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesia, Division of Pain Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA;
| | | | - Ashley M. Scherer
- Center for Pain Control PC, Lancaster, PA 19610, USA; (M.A.F.); (A.M.S.)
| | - Brendan Schetzner
- Department of Anesthesiology, St Elizabeths Medical Center, Brighton, MA 02135, USA;
| | - Malvina Klusek
- Peconic Bay Medical Center/Northwell Health, New York, NY 10065, USA;
| | | | - Stephen Meloni
- Thermaquil, Inc., Philadelphia, PA 19610, USA; (S.R.P.); (S.M.)
| | - Steven Falowski
- Neurosurgical Associates of Lancaster, Lancaster, PA 19610, USA;
| | - Philip Kim
- Center for Interventional Pain Spine, LLC, Wilmington, DE 19803, USA;
| | - Konstantin V. Slavin
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL 60607, USA;
- Neurology Service, Jesse Brown Veterans Administration Medical Center, Chicago, IL 60612, USA
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Lee G, Ray E, Yoon HJ, Genovese S, Choi YS, Lee MK, Şahin S, Yan Y, Ahn HY, Bandodkar AJ, Kim J, Park M, Ryu H, Kwak SS, Jung YH, Odabas A, Khandpur U, Ray WZ, MacEwan MR, Rogers JA. A bioresorbable peripheral nerve stimulator for electronic pain block. SCIENCE ADVANCES 2022; 8:eabp9169. [PMID: 36197971 PMCID: PMC9534494 DOI: 10.1126/sciadv.abp9169] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 08/18/2022] [Indexed: 05/31/2023]
Abstract
Local electrical stimulation of peripheral nerves can block the propagation of action potentials, as an attractive alternative to pharmacological agents for the treatment of acute pain. Traditional hardware for such purposes, however, involves interfaces that can damage nerve tissue and, when used for temporary pain relief, that impose costs and risks due to requirements for surgical extraction after a period of need. Here, we introduce a bioresorbable nerve stimulator that enables electrical nerve block and associated pain mitigation without these drawbacks. This platform combines a collection of bioresorbable materials in architectures that support stable blocking with minimal adverse mechanical, electrical, or biochemical effects. Optimized designs ensure that the device disappears harmlessly in the body after a desired period of use. Studies in live animal models illustrate capabilities for complete nerve block and other key features of the technology. In certain clinically relevant scenarios, such approaches may reduce or eliminate the need for use of highly addictive drugs such as opioids.
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Affiliation(s)
- Geumbee Lee
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Precision Biology Research Center, Sungkyunkwan University, Suwon 16419, Republic of Korea
| | - Emily Ray
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Hong-Joon Yoon
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Sabrina Genovese
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Yeon Sik Choi
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Min-Kyu Lee
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Samet Şahin
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Department of Bioengineering, Bilecik Şeyh Edebali University, 11230 Bilecik, Merkez/Bilecik, Turkey
| | - Ying Yan
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Hak-Young Ahn
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Amay J. Bandodkar
- Department of Electrical and Computer Engineering, North Carolina State University, Raleigh, NC 27606, USA
- Center for Advanced Self-Powered Systems of Integrated Sensors and Technologies (ASSIST), North Carolina State University, Raleigh, NC 27606, USA
| | - Joohee Kim
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Minsu Park
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Hanjun Ryu
- Department of Advanced Materials Engineering, Chung-Ang University, Anseong 17546, Republic of Korea
| | - Sung Soo Kwak
- Center for Bionics, Biomedical Research Division, Korea Institute of Science and Technology, Seoul 02792, Republic of Korea
| | - Yei Hwan Jung
- Department of Electronic Engineering, Hanyang University, Seoul 04763, Republic of Korea
| | - Arman Odabas
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
- Department of Internal Medicine, Stanford University Medical Center, Stanford, CA 94305, USA
| | - Umang Khandpur
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Wilson Z. Ray
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Matthew R. MacEwan
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - John A. Rogers
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Mechanical Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
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