Breathing-controlled Electrical Stimulation for Phantom Pain Management

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 DESCRIPTION (provided by applicant): Neuropathic pain (phantom limb pain) after traumatic amputation is a common problem. Pathophysiological mechanisms underlying phantom limb pain are not well understood, though several mechanisms were proposed in the past. Our recent research findings suggest central sensitization as a plausible mechanism mediating phantom pain after traumatic amputation. We have recently developed a non-pharmacological intervention - Breathing-controlled electrical stimulation (BreEStim) for neuropathic pain management. This novel non- pharmacological intervention is found to result in central desensitization according to our recent studies in healthy pain-free subjects. The goal of this proposal is to explore the effectiveness of BreEStim via its central desensitization in phantom limb pain in patients after traumatic limb amputation. It is therefore hypothesized that BreEStim could provide non- pharmacological analgesic effects for patients with chronic phantom limb pain after traumatic amputation via central desensitization effects. Specific Aim 1: To compare analgesic effects on phantom pain between BreEStim and EStim. It is hypothesized that BreEStim has better analgesic effect than EStim, and the analgesic effect is accompanied by elevated electrical pain thresholds. Specific Aim 2: To examine the "dose-response" effect of BreEStim on phantom limb pain It is hypothesized that there is a dose-response analgesic effect of BreEStim, i.e., an increased "dose" of BreEStim will have a greater impact on reduction of phantom limb pain. At the completion of this project, the findings will provide evidence that BreEStim is likely to be effective for management of phantom limb pain after traumatic amputation. The findings will also provide the basis for future mechanistic studies, such as imaging studies and endorphin measurement, particularly regarding differential management of affective component of neuropathic pain with electrical stimulation.