scholarly journals Alpha entrainment drives pain relief using visual stimulation in a sample of chronic pain patients. A proof-of-concept controlled study.

2020 ◽  
Author(s):  
Karen Lopez-Diaz ◽  
James Henshaw ◽  
Alex Casson ◽  
Christopher Brown ◽  
Jason R. Taylor ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Intensity ◽  
Visual Stimulation ◽  
Pharmacological Intervention ◽  
Controlled Study ◽  
Alpha Power ◽  
Proof Of Concept ◽  
Home Setting ◽  
Non Invasive ◽  
Pain Unpleasantness

One-third of the population in the UK and worldwide struggle with chronic pain. Entraining brain alpha activity through non-invasive visual stimulation has been shown to reduce experimental pain in healthy volunteers. Neural oscillations entrainment offers a potential non-invasive and non-pharmacological intervention for patients with chronic pain, which can be delivered in the home setting and has the potential to reduce use of medications. However, evidence supporting its use in patients with chronic pain is lacking. This study explores whether a) alpha entrainment increase alpha power in patients and b) whether this increase in alpha correlates with analgesia.28 patients with chronic pain sat in a comfortable position and underwent 4-minute visual stimulation using customised goggles at 10 Hz (alpha) and 7 Hz (control) frequency blocks in a randomised cross-over design. 64-channel Electroencephalography (EEG) and 11-point Numeric Rating Scale (NRS) pain intensity and pain unpleasantness scores were recorded before and after stimulation.EEG analysis revealed frontal alpha power was significantly higher when stimulating at 10 Hz when compared to 7 Hz. There was a significant positive correlation between increased frontal alpha and reduction in pain intensity (r=0.33, p<0.05) and pain unpleasantness (r=0.40, p<0.05) in the 10 Hz block.This study provides the first proof of concept that changes in alpha power resulting from entrainment correlate with an analgesic response in patients with chronic pain. Further studies are warranted to investigate dose-response parameters and equivalence to analgesia provided by medications.

scholarly journals Entraining alpha activity using visual stimulation in patients with chronic musculoskeletal pain. A feasibility study

2020 ◽  
Author(s):  
Laura J. Arendsen ◽  
James Henshaw ◽  
Christopher A. Brown ◽  
Manoj Sivan ◽  
Jason R. Taylor ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Intensity ◽  
Musculoskeletal Pain ◽  
Feasibility Study ◽  
Rating Scale ◽  
Visual Stimulation ◽  
Numerical Rating Scale ◽  
Alpha Activity ◽  
Chronic Musculoskeletal Pain ◽  
Alpha Power

AbstractEntraining alpha activity with rhythmic visual, auditory, and electrical stimulation can reduce experimentally induced pain. However, evidence for alpha entrainment and pain reduction in patients with chronic pain is limited. This feasibility study investigated whether visual alpha stimulation can increase alpha power in patients with chronic musculoskeletal pain and secondarily, if chronic pain was reduced following stimulation. In a within-subject design, 22 patients underwent 4-minute periods of stimulation at 10 Hz (alpha), 7 Hz (high-theta, control), and 1 Hz (control) in a pseudo-randomized order. Patients underwent stimulation both sitting and standing and verbally rated their pain before and after each stimulation block on a 0-10 numerical rating scale. Global alpha power was significantly higher during 10 Hz compared to 1 Hz stimulation when patients were standing (t = −6.08, p <.001). On a more regional level, a significant increase of alpha power was found in the right-middle and left-posterior region when patients were sitting. With respect to our secondary aim, no significant reduction of pain intensity and unpleasantness was found. However, only the alpha stimulation resulted in a minimal clinically important difference in at least 50% of participants for pain intensity (50%) and unpleasantness ratings (65%) in the sitting condition. This study provides initial evidence for the potential of visual stimulation as a means to enhance alpha activity in patients with chronic musculoskeletal pain. The brief period of stimulation was insufficient to reduce chronic pain. This study is the first to provide evidence that a brief period of visual stimulation at alpha frequency can significantly increase alpha power in patients with chronic musculoskeletal pain. Further study is warranted to investigate optimal dose and individual stimulation parameters to achieve pain relief in these patients.

scholarly journals 0794 Reduction in Restless Legs Syndrome Symptoms with Non-Invasive Peripheral Nerve Stimulation

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A302-A302
Author(s):  
J D Charlesworth ◽  
F C Baker ◽  
V Kolotovska ◽  
B Adlou ◽  
M de Zambotti ◽  
...  
Keyword(s):  
Medical Device ◽  
Restless Legs Syndrome ◽  
Therapeutic Efficacy ◽  
Rating Scale ◽  
Pharmacological Intervention ◽  
Controlled Study ◽  
Promising Alternative ◽  
Restless Legs ◽  
Non Invasive ◽  
Clinically Significant

Abstract Introduction Restless Legs Syndrome (RLS) is a sensorimotor neurological condition characterized by an uncontrollable urge to move the legs that interferes with falling and staying asleep. For the over 5 million Americans with clinically significant RLS, these symptoms occur multiple nights per week, significantly impair quality of life, increase the prevalence of depression and anxiety, and increase suicide risk. FDA-approved medications for RLS are associated with progressively worsening RLS symptoms and numerous adverse events, whereas existing medical device treatments have limited efficacy. Methods We evaluated a novel neurostimulation intervention for RLS developed by Noctrix Health; electrical stimulation was applied non-invasively and bilaterally to the peroneal nerve of patients with moderate-to-severe primary RLS. Stimulation parameters were engineered to maximize therapeutic efficacy while minimizing interference with sleep. To assess the therapeutic efficacy of this technique, we conducted a multi-site randomized patient-blinded crossover trial comparing active neurostimulation treatment to a sham device. Following a lab visit for calibration, optimization, and training, each patient was instructed to self-administer each treatment - active and sham - for 14 consecutive nights at home. Results Active neurostimulation treatment resulted in a clinically significant reduction in RLS severity of 4.2 points on the International RLS Rating Scale (IRLS) relative to sham (P&lt;0.01), comparable to FDA-approved medications. Moreover, 79% of patients demonstrated a clinically significant improvement on the Clinical Global Impressions-Improvement scale (CGI-I) compared to 7% for sham (P&lt;0.01). Conclusion To our knowledge, this is the first sham-controlled study demonstrating a clinically significant reduction in RLS severity resulting from a non-pharmacological intervention. This therapeutic effect was sustained over 2-weeks of in-home patient-administered usage, indicating consistent efficacy. A medical device based on this technology could be a promising alternative or complement to medications. Support Funding was provided by Noctrix Health, Inc.

scholarly journals Effects of Linear-Polarized Near-Infrared Light Irradiation on Chronic Pain

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Dong Huang ◽  
Yong-Hong Gu ◽  
Qin Liao ◽  
Xue-Bin Yan ◽  
Shai-Hong Zhu ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Intensity ◽  
Near Infrared ◽  
Light Irradiation ◽  
Pain Clinic ◽  
Infrared Light ◽  
Controlled Study ◽  
Near Infrared Light ◽  
Group I ◽  
Significant Difference

In order to study the efficacy of linear-polarized near-infrared light irradiation (LPNIR) on relieving chronic pain in conjunction with nerve block (NB) or local block (LB), a 3-week prospective, randomized, double-blind, controlled study was conducted to evaluate the pre- and post-therapy pain intensity. Visual analogue scales (VASs) were measured in all patients before and 6 months after therapy visiting the pain clinic during the period of August 2007 to January 2008. A total of 52 patients with either shoulder periarthritis or myofascial pain syndrome or lateral epicondylitis were randomly assigned into two groups by drawing lots. Patients in Group I were treated with NB or LB plus LPNIR; Group II patients, for their part, were treated with the same procedures as in Group I, but not using LPNIR. In both groups, the pain intensity (VAS score) decreased significantly immediately after therapy as compared to therapy. There was a significant difference between the test and control groups immediately after therapy (P<0.05), while no effect 6 months later. No side effects were observed. It is concluded that LPNIR is an effective and safe modality to treat various chronic pains, which has synergic effects with NB or LB.

scholarly journals Transient reductions in postoperative pain and anxiety using virtual reality in children

2020 ◽  
Author(s):  
Vanessa A. Olbrecht ◽  
Keith T O'Conor ◽  
Sara E Williams ◽  
Chloe O Boehmer ◽  
Gilbert W Marchant ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Postoperative Pain ◽  
Pain Intensity ◽  
Anxiety Sensitivity ◽  
Pain Catastrophizing ◽  
Medical Center ◽  
Controlled Study ◽  
Acute Postoperative Pain ◽  
Lower Pain ◽  
Pain Unpleasantness

Objective: Virtual reality (VR) is a promising method to manage pain. Distraction-based VR (VR-D) is thought to reduce pain by redirecting attention. While VR-D can reduce pain associated with acutely painful procedures, it is unclear if VR-D can reduce pain after surgery. We assessed the ability of a single VR-D session to decrease acute postoperative pain and anxiety and explored if pain catastrophizing and anxiety sensitivity influenced the ability of VR-D to reduce these outcomes in children following surgery. Design: Single-center, prospective, pilot study Setting: Cincinnati Childrens Hospital Medical Center (CCHMC) Subjects: 50 children/adolescents (age 7-21 years) with postoperative pain followed by the Acute Pain Service Methods: Patients received a single VR-D session following surgery. Prior to the VR-D session, patients completed pain catastrophizing (PCS-C) and anxiety sensitivity (CASI) questionnaires. Primary outcome consisted of changes in pain intensity following VR-D (immediately, 15, and 30 minutes). Secondary outcomes included changes in pain unpleasantness and anxiety. Results: VR-D decreased pain intensity immediately and 15-minutes after VR-D. Reductions in pain unpleasantness were observed up to 30 minutes following VR-D. Anxiety was also reduced immediately and at 15-minutes following VR-D. While patients with higher pain catastrophizing had higher baseline pain intensity and unpleasantness, they did not show larger pain reductions following VR-D compared to those with lower pain catastrophizing. Conclusions: VR-D is beneficial in transiently reducing pain intensity, unpleasantness, and anxiety in children with acute postoperative pain. This study informs design of larger, controlled study assessing VR-D for acute postoperative pain and anxiety.

Collecting patient reported outcomes to facilitate prescription opioid management: Development and testing of the Opioid Management App (OM-App) (Preprint)

2020 ◽  
Author(s):  
Jessica Robinson-Papp ◽  
Gabriela Cedillo ◽  
Richa Deshpande ◽  
Mary Catherine George ◽  
Qiuchen Yang ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Intensity ◽  
Risk Behaviors ◽  
Digital Health ◽  
Monitoring Program ◽  
Prescription Opioid ◽  
Research Database ◽  
Cross Sectional ◽  
Study Duration ◽  
Patient Reported

BACKGROUND Collecting patient-reported data needed by clinicians to adhere to opioid prescribing guidelines represents a significant time burden. OBJECTIVE We developed and tested an opioid management app (OM-App) to collect these data directly from patients. METHODS OM-App used a pre-existing digital health platform to deliver daily questions to patients via text-message and organize responses into a dashboard. We pilot tested OM-App over 9 months in 40 diverse participants with HIV who were prescribed opioids for chronic pain. Feasibility outcomes included: ability to export/integrate OM-App data with other research data; patient-reported barriers and adherence to OM-App use; capture of opioid-related harms, risk behaviors and pain intensity/interference; comparison of OM-App data to urine drug testing, prescription drug monitoring program data, and validated questionnaires. RESULTS OM-App data was exported/integrated into the research database after minor modifications. Thirty-nine of 40 participants were able to use OM-App, and over the study duration 70% of all OM-App questions were answered. Although the cross-sectional prevalence of opioid-related harms and risk behaviors reported via OM-App was low, some of these were not obtained via the other measures, and over the study duration all queried harms/risks were reported at least once via OM-App. Clinically meaningful changes in pain intensity/interference were captured. CONCLUSIONS OM-App was used by our diverse patient population to produce clinically relevant opioid- and pain-related data, which was successfully exported and integrated into a research database. These findings suggest that OM-App may be a useful tool for remote monitoring of patients prescribed opioids for chronic pain. CLINICALTRIAL NCT03669939 INTERNATIONAL REGISTERED REPORT RR2-doi:10.1016/j.conctc.2019.100468

scholarly journals Cerebellar rTMS in PSP: a Double-Blind Sham-Controlled Study Using Mobile Health Technology

2021 ◽  
Author(s):  
Andrea Pilotto ◽  
Maria Cristina Rizzetti ◽  
Alberto Lombardi ◽  
Clint Hansen ◽  
Michele Biggi ◽  
...  
Keyword(s):  
Digital Technology ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Health Technology ◽  
Controlled Study ◽  
Double Blind ◽  
Non Invasive ◽  
Lower Back ◽  
Before And After ◽  
Double Blind Design ◽  
Theta Burst

AbstractThere are no effective treatments in progressive supranuclear palsy (PSP). The aim of this study was to test the efficacy of theta burst repetitive transcranial magnetic stimulation (rTMS) on postural instability in PSP. Twenty PSP patients underwent a session of sham or real cerebellar rTMS in a crossover design. Before and after stimulation, static balance was evaluated with instrumented (lower back accelerometer, Rehagait®, Hasomed, Germany) 30-s trials in semitandem and tandem positions. In tandem and semitandem tasks, active stimulation was associated with increase in time without falls (both p=0.04). In the same tasks, device-extracted parameters revealed significant improvement in area (p=0.007), velocity (p=0.005), acceleration and jerkiness of sway (p=0.008) in real versus sham stimulation. Cerebellar rTMS showed a significant effect on stability in PSP patients, when assessed with mobile digital technology, in a double-blind design. These results should motivate larger and longer trials using non-invasive brain stimulation for PSP patients.

scholarly journals A functional linear modeling approach to sleep–wake cycles in dogs

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Hope J. Woods ◽  
Ming Fei Li ◽  
Ujas A. Patel ◽  
B. Duncan X. Lascelles ◽  
David R. Samson ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Cognitive Dysfunction ◽  
Healthy Adult ◽  
Activity Patterns ◽  
Linear Modeling ◽  
Activity Monitors ◽  
Companion Dogs ◽  
Non Invasive ◽  
Normal Sleep ◽  
The Times

AbstractThe study of companion (pet) dogs is an area of great translational potential, as they share a risk for many conditions that afflict humans. Among these are conditions that affect sleep, including chronic pain and cognitive dysfunction. Significant advancements have occurred in the ability to study sleep in dogs, including development of non-invasive polysomnography; however, basic understanding of dog sleep patterns remains poorly characterized. The purpose of this study was to establish baseline sleep–wake cycle and activity patterns using actigraphy and functional linear modeling (FLM), for healthy, adult companion dogs. Forty-two dogs were enrolled and wore activity monitors for 14 days. FLM demonstrated a bimodal pattern of activity with significant effects of sex, body mass, and age; the effect of age was particularly evident during the times of peak activity. This study demonstrated that FLM can be used to describe normal sleep–wake cycles of healthy adult dogs and the effects of physiologic traits on these patterns of activity. This foundation makes it possible to characterize deviations from normal patterns, including those associated with chronic pain and cognitive dysfunction syndrome. This can improve detection of these conditions in dogs, benefitting them and their potential as models for human disease.

scholarly journals Conscious perception and perceptual echoes: a binocular rivalry study

2021 ◽  
Vol 2021 (1) ◽  
Author(s):  
Canhuang Luo ◽  
Rufin VanRullen ◽  
Andrea Alamia
Keyword(s):  
Binocular Rivalry ◽  
Visual Information ◽  
Visual Stimulation ◽  
Brain Regions ◽  
Travelling Wave ◽  
Alpha Power ◽  
Conscious Perception ◽  
Impulse Response Functions ◽  
Band Frequency ◽  
Underlying Mechanisms

Abstract Alpha rhythms (∼10Hz) in the human brain are classically associated with idling activities, being predominantly observed during quiet restfulness with closed eyes. However, recent studies demonstrated that alpha (∼10Hz) rhythms can directly relate to visual stimulation, resulting in oscillations, which can last for as long as one second. This alpha reverberation, dubbed perceptual echoes (PE), suggests that the visual system actively samples and processes visual information within the alpha-band frequency. Although PE have been linked to various visual functions, their underlying mechanisms and functional role are not completely understood. In this study, we investigated the relationship between conscious perception and the generation and the amplitude of PE. Specifically, we displayed two coloured Gabor patches with different orientations on opposite sides of the screen, and using a set of dichoptic mirrors, we induced a binocular rivalry between the two stimuli. We asked participants to continuously report which one of two Gabor patches they consciously perceived, while recording their EEG signals. Importantly, the luminance of each patch fluctuated randomly over time, generating random sequences from which we estimated two impulse-response functions (IRFs) reflecting the PE generated by the perceived (dominant) and non-perceived (suppressed) stimulus, respectively. We found that the alpha power of the PE generated by the consciously perceived stimulus was comparable with that of the PE generated during monocular vision (control condition) and higher than the PE induced by the suppressed stimulus. Moreover, confirming previous findings, we found that all PEs propagated as a travelling wave from posterior to frontal brain regions, irrespective of conscious perception. All in all our results demonstrate a correlation between conscious perception and PE, suggesting that the synchronization of neural activity plays an important role in visual sampling and conscious perception.

scholarly journals The Pain Situation of Older Home-Care Recipients and Influencing Factors

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 204-205
Author(s):  
Dagmar Dräger ◽  
Reinhold Kreutz ◽  
Adelheid Kuhlmey ◽  
Andrea Budnick ◽  
Dagmar Draeger
Keyword(s):  
Chronic Pain ◽  
Home Care ◽  
Older People ◽  
Pain Intensity ◽  
Prevalence Rate ◽  
Severe Pain ◽  
Self Report ◽  
Primary Data ◽  
Common Symptom ◽  
Care Recipients

Abstract Chronic pain is a common symptom among older people. The international prevalence rate reaches 50% for older home-care recipients (aged ≥60). The most common causes of pain among older people are degenerative arthropathy and musculoskeletal diseases. Care recipients (81% aged ≥65) constitute a specific sub-group among pain patients, due to the restrictions they experience. In Germany, the prevalence rate in this group is 70%. Currently, no comprehensive information on the pain situation of older home-care recipients exists in Germany. The findings presented are based on a cross-sectional study of older (aged ≥65) home-care recipients (SGB XI) in Berlin, with chronic pain (n=225), capable of self-report (MMST≥18). Structured interviews comprised the primary data source. The pain situation was determined using the German Brief Pain Inventory (BPI-NH). Multiple regression analysis was applied to test how the most severe pain (dependent variable) was influenced by socio-demographic and medical parameters, mental and physical restrictions and pain medication. Analyses of the pain situation show a value of M=4.81 (SD±1.88) on the BPI intensity index, and a BPI pain interference index of M=5.47 (SD±2.15). The most intense pain averaged 6.96 (SD±2.15). On average, respondents reported 16.20 (SD±13.25) pain locations (range: 0-65). The number of pain locations, alongside other factors, had a significant influence, R²=0.038 (corrected R²=0.034), F (1.219) = 8.760, p&lt;0.01), on pain intensity. The findings show severe pain intensity among older home-care recipients not reported in previous findings (e.g. in long-term in-patient care). Action in medical care, nursing care and educational aspects is urgently needed.

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