Neurotechnology for Chronic Pain

至少有20%的英国人患有临床上显著的慢性疼痛，这使得慢性疼痛在临床和社会经济影响方面几乎是无与伦比的。目前可用的药理学和非药理学解决方案的匮乏加剧了这一问题。然而，最近在了解慢性疼痛的神经生物学机制方面的进展为神经技术创造了一个巨大但尚未开发的机会，有能力完全改变慢性疼痛的临床格局。实现这一能力至关重要地取决于创建一个技术和临床基础设施，该基础设施将跨学科的专业知识(研究人员、临床医生、患者)、不同的慢性疼痛状况(伤害性、神经病理性、神经症性)和不同的技术工具聚集在一起。从神经工程学的角度来看，这将允许技术整合，重点放在由神经生物机制提供信息的关键战略目标上。这有能力推动与慢性疼痛及其相关的疲劳、抑郁和焦虑相关的神经变化，恢复正常的健康状态，并对多种医疗条件和慢性病产生重大影响，其中许多疾病的最大问题是慢性疼痛。我们的中心目标是创建一个全面的网络，致力于发现和增强慢性疼痛神经技术的能力，使目前可用的治疗方法发生阶段性变化。我们将全面参与研究人员、临床医生、患者和其他利益相关者，以i)定义当前形势并确定关键的机会和挑战；ii)参与专注于慢性疼痛的技术开发的创新发现研究；iii)通过支持ECR、教育和培训以及启动新的英国和国际合作，为疼痛神经技术创建可持续的基础设施。我们的科学和技术重点是构建结合核心技术的集成系统，通常作为闭环系统：例如，使用外设传感器检测伤害性反射的闭环神经刺激，使用神经刺激的认知VR，认知和行为数字治疗中的脑电神经反馈，以及其他。其目的是建立以一种有针对性的、治疗上互动的、在实践和临床上可行的方式结合个别技术的能力。我们将进行一系列可行性研究，测试具体的综合策略，并展示如何使用这些不同的部件来进一步设计更全面的疼痛治疗系统。最终，它的目标是建立新一代成本效益高、患者友好、个性化和可在国内使用的技术，这些技术可以与临床和行业合作伙伴共同开发。我们的主要成果和产出将包括：i)一套战略文件和科学审查，涵盖概念框架开发、临床翻译的途径以及伦理和可获得性；ii)一系列活动，包括研讨会、沙坑和一个大型公共展览；iii)一套新的合作研究可行性项目；iv)一项重大教育计划，包括一系列全面的研讨会、广泛的研究人员交流计划、新的ECR试点项目的专项资金和雄心勃勃的英国导师计划；v)一套基于网络的资源，包括公众参与媒体输出和患者信息；以及由网络产生的开放式技术、软件工具和数据(例如，用于闭环系统的软件API)。该网络将面向外部，旨在与英国各地的所有相关研究人员和利益攸关方建立联系，建立一个可持续的研究基础设施，专注于当前和长期的研究和影响交付。

At least 20% of the UK population suffer from clinically significant chronic pain, making chronic pain almost unparalleled in its clinical and socioeconomic impact. The problem is amplified by the paucity of currently available pharmacological and non-pharmacological solutions. However recent advances in our understanding of the neurobiological mechanisms of chronic pain have created an enormous but untapped opportunity for neurotechnology, with the capacity to completely transform the clinical landscape of chronic pain. Realising this capacity depends critically on creating a technological and clinical infrastructure that brings together interdisciplinary expertise (researchers, clinicians, patients), different chronic pain conditions (nociceptive, neuropathic, nociplastic), and different technological tools. From a neuroengineering perspective, this will allow technological integration with a focus on key strategic targets informed by neurobiological mechanisms. This has the power to drive neural changes associated with chronic pain - as well as its associated fatigue, depression and anxiety, towards recovering a normal state of health, and deliver major impact across multiple medical conditions and chronic illnesses, many of which have chronic pain as their single most problematic facet. Our central objective is to create a comprehensive network dedicated to discovery and enhancing capability of chronic pain neurotechnology, to bring about a step-change in current available therapeutics. We will engage fully across the spectrum of researchers, clinicians, patients, and other stakeholders to i) define the current landscape and identify key opportunities and challenges; ii) engage in an innovative discovery research focused on technology development chronic pain, and iii) create a sustainable infrastructure for pain neurotechnology by supporting ECRs, education and training, and seeding new UK and international collaborations. Our scientific and technical focus is based on building integrated systems that combine core technologies, typically as closed-loop systems: for example closed-loop neurostimulation using peripheral sensor detection of nociceptive reflexes, cognitive VR with neurostimulation, EEG neurofeedback within cognitive and behavioural digital therapy, and others. The aim is to build the capability to combine individual technologies in a way that is target-focused, therapeutically interactive, and practically and clinically feasible. We will undertake a set of feasibility studies that test specific integrative strategies and show how these different pieces can be used to further design more comprehensive pain therapy systems. Ultimately this aims to build a new generation of cost-effective, patient-friendly, personalised and domestically usable technologies that can be developed with clinical and industry partners. Our major deliverables and outputs will i) a set of strategy documents and scientific reviews covering conceptual framework development, pathways to clinical translation, and ethics and accessibility, ii) a series of events including workshops, sandpits, and a major public exhibition, iii) a set of new collaborative research feasibility projects; iv) a major educational program including a comprehensive seminar series, an extensive researcher exchange program, dedicated funds for new ECR pilot projects, and an ambitious UK mentorship program, v) a set of web-based resources including public engagement media outputs and patient information; as well as open technical, software tools and data produced by the network (e.g. software APIs for closed-loop systems). The network will be outwardly looking with the aim to establish links with all related researchers and stakeholders across the UK, building a sustainable research infrastructure focused on research and impact delivery both now and into the long term.