Breathing-controlled Electrical Stimulation for Phantom Pain Management

 描述（由申请人提供）：创伤性截肢后的神经性疼痛（幻肢痛）是一种常见问题。幻肢痛的病理生理机制尚未完全了解，尽管过去提出了几种机制。我们最近的研究结果表明，中枢敏化作为一个合理的机制介导创伤性截肢后幻痛。我们最近开发了一种非药物干预-呼吸控制电刺激（BreEStim）用于神经性疼痛管理。根据我们最近在健康无痛受试者中的研究，发现这种新型非药物干预导致中枢脱敏。本提案的目的是探索BreEStim通过其中枢脱敏治疗创伤性截肢患者幻肢痛的有效性。因此，假设BreEStim可通过中枢脱敏作用为创伤性截肢后慢性幻肢痛患者提供非药理学镇痛作用。具体目的1：比较BreEStim和ESTim对幻肢痛的镇痛作用。假设BreEStim的镇痛效果优于EStim，且镇痛效果伴随电痛阈升高。具体目标二：为了检查BreESTim对幻肢痛的“剂量-反应”效应，假设存在BreESTim的剂量-反应镇痛效应，即，增加BreEStim的“剂量”将对减少幻肢疼痛产生更大的影响。在该项目完成时，研究结果将提供证据证明BreEStim可能有效治疗创伤性截肢后的幻肢疼痛。这些发现也将为未来的机制研究提供基础，如成像研究和内啡肽测量，特别是关于电刺激神经性疼痛的情感成分的差异管理。

 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.