Kilohertz Frequency Alternating Current Spinal Cord Stimulation for Chronic Pain Relief

千赫兹频率交流脊髓刺激可缓解慢性疼痛

• 批准号: 9132358
• 负责人: KEVIN L. KILGORE
• 金额: $ 60.38万
• 依托单位: CASE WESTERN RESERVE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-01 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9132358
• 关键词: Affect; Animal Model; Back; Bilateral; Chronic; Clinical; Computer Simulation; Conflict (Psychology); Conscious; Coupled; Development; Devices; Electrodes; Engineering; Failure; Foundations; Frequencies; Future; Geometry; Goals; Health; Intractable Pain; Knowledge; Limb structure; Location; Low Back Pain; Measurement; Methods; Modality; Modeling; Nerve Block; Nervous system structure; Neural Conduction; Neurostimulation procedures of spinal cord tissue; Outcome; Pain; Pain Disorder; Pain in lower limb; Paresthesia; Patients; Perception; Peripheral Nerves; Physiology; Population; Rattus; Recording of previous events; Refractory; Reporting; Spinal Cord; Spinal nerve root structure; Structure; System; Technology; Testing; Tissues; base; chronic neuropathic pain; chronic pain; design; improved; improved outcome; in vivo; in vivo Model; model development; neuroregulation; novel; prototype; relating to nervous system; research clinical testing; response; success; surgical pain; theories; tool

 DESCRIPTION (provided by applicant): Chronic pain is the most prevalent health problem worldwide and is often inadequately treated. Spinal cord stimulation (SCS) is a widely used, non-destructive, reversible therapy for treatment of chronic pain, particularly used when other conservative modalities have failed. Recently, the use of kilohertz frequency alternating current (KHFAC) SCS has shown potential for significantly improved outcomes, but conflicting results have been reported. KHFAC has been shown to produce a rapid and reversible conduction block in peripheral nerves. Preliminary evidence suggests that KHFAC SCS may produce pain relief without concomitant paresthesia (unlike conventional SCS), and thus significant excitement has been generated regarding this new modality. However, the mechanism by which KHFAC SCS might produce pain relief, and the differences between the neural response at kilohertz frequencies compared to conventional SCS, are poorly understood. We hypothesize that KHFAC SCS, as currently implemented, does not produce a block of neural activity but rather acts to modulate ongoing neural activity. The critical factors that determine the action of KHFAC SCS begin with the details of the technology itself, extend through its action on the spinal cord, and ultimately to the conscious perception of pain. Through the aims in this study, we anticipate demonstrating the mechanisms underlying the early clinical success (and failures) of KHFAC SCS, thus providing critical information for the field of neuromodulation. We further hypothesize that the unique features of KHFAC, which include the capacity to activate, block, and modulate activity in neural structures, could be fully exploited by the development of novel KHFAC SCS systems designed specifically to take advantage of these features. Such a system could have a significant impact on SCS clinical outcomes and responder rates. KHFAC SCS may represent one of the most exciting advances in the field SCS over its 40 year history. If successful, this project will provide the foundation for a new an powerful modality for the treatment of refractory chronic pain.

 描述（由申请人提供）：慢性疼痛是世界范围内最普遍的健康问题，通常治疗不足。 脊髓电刺激（SCS）是一种广泛使用的、非破坏性的、可逆的治疗慢性疼痛的疗法，特别是在其他保守疗法失败时使用。 最近，使用千赫频率交流电（KHFAC）SCS显示出显著改善结局的潜力，但报告了相互矛盾的结果。 KHFAC已被证明在周围神经中产生快速和可逆的传导阻滞。 初步证据表明，KHFAC SCS可能会缓解疼痛，而不会伴随感觉异常（与传统SCS不同），因此，这种新方式引起了极大的兴奋。 然而，KHFAC SCS可能产生疼痛缓解的机制，以及与传统SCS相比，在千赫兹频率下的神经反应之间的差异，知之甚少。 我们假设，KHFAC SCS，目前实施，不产生一个块的神经活动，而是采取行动，以调节正在进行的神经活动。 决定KHFAC SCS作用的关键因素开始于技术本身的细节，通过其对脊髓的作用延伸，并最终达到对疼痛的有意识感知。 通过本研究的目的，我们预计将证明KHFAC SCS早期临床成功（和失败）的机制，从而为神经调节领域提供关键信息。 我们进一步假设，KHFAC的独特功能（包括激活、阻断和调节神经结构活动的能力）可以通过开发专门设计用于利用这些功能的新型KHFAC SCS系统来充分利用。 这种系统可能对SCS临床结局和应答率产生显著影响。 KHFAC SCS可能代表了SCS领域40年历史上最令人兴奋的进展之一。 如果成功，该项目将为治疗难治性慢性疼痛提供一种新的强大模式。