Pain is reduced by transcutaneous cervical vagus nerve stimulation and correlated with cardiorespiratory variability measures in the context of opioid withdrawal.
Pain is reduced by transcutaneous cervical vagus nerve stimulation and correlated with cardiorespiratory variability measures in the context of opioid withdrawal.
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DOI：
10.3389/fpain.2022.1031368
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发表时间：
2022
期刊：
影响因子：
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2021年，美国有超过10万人死于药物过量，其中阿片使用障碍(OUD)是主要原因。疼痛是阿片类药物戒断的一个重要组成部分，它会使OUD的康复变得复杂。本研究的目的是评估经皮颈部迷走神经刺激(TcVNS)对急性阿片类药物戒断期间疼痛的影响，并研究疼痛与客观心肺标志物的关系。20名OUD患者在参与两小时方案的同时接受了阿片类药物的戒断。该协议涉及阿片类药物线索以诱导阿片类药物渴望和中性条件用于控制目的。遵循双盲设计，在整个方案中，患者被随机分配接受活跃的tcVNS(n = 9)或假刺激(n = 11)。在方案的开始和结束时，使用疼痛(NRS疼痛)的数字分级标准(0-10分)评估患者的疼痛水平。在该方案中，测量心电和呼吸努力信号，从中提取心率变异性(HRV)和呼吸模式变异性(RPV)。计算所有测量的变更前后(用Δ表示)。活动组Δ疼痛评分( = 0.045)(平均 ± 标准差：−0.8 ± 2.4)低于假手术组(0.9 ± 1.0)。Δ疼痛评分与ΔRPV呈正相关(ρ = 为0.46；P = 为0.0 4)。调整装置组后，Δ心率变异性与Δ疼痛呈负相关(ρ = −为0.43；P = 为0.04)。这项随机、双盲、假对照的先导研究首次证明了tcVNS可减轻正在经历阿片类药物戒断的患者的疼痛。这项研究还首次提供了呼吸不规律和疼痛之间存在联系的定量证据。疼痛变化和客观生理标记物变化之间的相关性增加了数据的有效性。鉴于非药物止痛的临床重要性，这些发现支持进一步研究tcVNS和可穿戴的心肺感知用于OUD患者的疼痛监测和管理。
Over 100,000 individuals in the United States lost their lives secondary to drug overdose in 2021, with opioid use disorder (OUD) being a leading cause. Pain is an important component of opioid withdrawal, which can complicate recovery from OUD. This study's objectives were to assess the effects of transcutaneous cervical vagus nerve stimulation (tcVNS), a technique shown to reduce sympathetic arousal in other populations, on pain during acute opioid withdrawal and to study pain's relationships with objective cardiorespiratory markers. Twenty patients with OUD underwent opioid withdrawal while participating in a two-hour protocol. The protocol involved opioid cues to induce opioid craving and neutral conditions for control purposes. Adhering to a double-blind design, patients were randomly assigned to receive active tcVNS (n = 9) or sham stimulation (n = 11) throughout the protocol. At the beginning and end of the protocol, patients' pain levels were assessed using the numerical rating scale (0–10 scale) for pain (NRS Pain). During the protocol, electrocardiogram and respiratory effort signals were measured, from which heart rate variability (HRV) and respiration pattern variability (RPV) were extracted. Pre- to post- changes (denoted with a Δ) were computed for all measures. Δ NRS Pain scores were lower (P = 0.045) for the active group (mean ± standard deviation: −0.8 ± 2.4) compared to the sham group (0.9 ± 1.0). A positive correlation existed between Δ NRS pain scores and Δ RPV (Spearman's ρ = 0.46; P = 0.04). Following adjustment for device group, a negative correlation existed between Δ HRV and Δ NRS Pain (Spearman's ρ = −0.43; P = 0.04). This randomized, double-blind, sham-controlled pilot study provides the first evidence of tcVNS-induced reductions in pain in patients with OUD experiencing opioid withdrawal. This study also provides the first quantitative evidence of an association between breathing irregularity and pain. The correlations between changes in pain and changes in objective physiological markers add validity to the data. Given the clinical importance of reducing pain non-pharmacologically, the findings support the need for further investigation of tcVNS and wearable cardiorespiratory sensing for pain monitoring and management in patients with OUD.
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影响因子：
4
作者：
Karri J;Zhang L;Li S;Chen YT;Stampas A;Li S
通讯作者：
Li S
影响因子：
2.6
作者：
Boiten, FA
通讯作者：
Boiten, FA
DOI：
10.1109/tbme.2021.3108135
发表时间：
2022-03
期刊：
IEEE transactions on bio-medical engineering
影响因子：
--
作者：
Gazi AH;Wittbrodt MT;Harrison AB;Sundararaj S;Gurel NZ;Nye JA;Shah AJ;Vaccarino V;Bremner JD;Inan OT
通讯作者：
Inan OT
影响因子：
4.9
作者：
Goadsby, P. J.;Grosberg, B. M.;Simmons, K. A.
通讯作者：
Simmons, K. A.
影响因子：
7.4
作者：
Garcia RG;Lin RL;Lee J;Kim J;Barbieri R;Sclocco R;Wasan AD;Edwards RR;Rosen BR;Hadjikhani N;Napadow V
通讯作者：
Napadow V