A novel nonpharmacological intervention – breathing-controlled electrical stimulation for neuropathic pain management after spinal cord injury – a preliminary study

Abstract

ObjectiveThe objective of this study was to examine the effectiveness of a novel nonpharmacological intervention – breathing-controlled electrical stimulation (BreEStim) – for neuropathic pain management in spinal cord injury (SCI) patients.Subjects and methodsThere were two experiments: 1) to compare the effectiveness between BreEStim and conventional electrical stimulation (EStim) in Experiment (Exp) 1 and 2) to examine the dose–response effect of BreEStim in Exp 2. In Exp 1, 13 SCI subjects (6 males and 7 females, history of SCI: 58.2 months, from 7 to 150 months, impairments ranging from C4 AIS B to L1 AIS B) received both BreEStim and EStim in a randomized order with at least 3 days apart. A total of 120 electrical stimuli to the median nerve transcutaneously were triggered by voluntary inhalation during BreEStim or were randomly delivered during EStim. In Exp 2, a subset of 7 subjects received BreEStim120 and 240 stimuli randomly on two different days with 7 days apart (BreEStim120 vs BreEStim240). The primary outcome variable was the visual analog scale (VAS) score.ResultsIn Exp 1, both BreEStim and EStim showed significant analgesic effects. Reduction in VAS score was significantly greater after BreEStim (2.6±0.3) than after EStim (0.8±0.3) (P<0.001). The duration of analgesic effect was significantly longer after BreEStim (14.2±6 hours) than after EStim (1.9±1 hours) (P=0.04). In Exp 2, BreEStim120 and BreEStim240 had similar degree and duration of analgesic effects.ConclusionThe findings from this preliminary study suggest that BreEStim is an effective alternative nonpharmacological treatment for chronic neuropathic pain in patients suffering from SCI.

Commentry on: Combined transcranial direct current stimulation and breathing controlled electrical stimulation for the management of neuropathic pain after spinal cord injury

“…However, we do not agree with the authors that BreEStim produces analgesic effects only for the arm. Our recent series of experiments has provided evidence that BreEStim has central analgesic effects in painfree healthy subjects (7-9) and in subjects with SCI (10,11). This study provided further evidence for this central analgesic effect.…”

Combined transcranial direct current stimulation and breathing-controlled electrical stimulation for management of neuropathic pain after spinal cord injury

“…The inclusion criteria were: SCI participants who: (i) had neuropathic pain after SCI with a score of 12 or above on the LANSS scale Leeds Assessment of Neuropatic Symptoms and Signs as in our previous study (33); (ii) were aged 18-75 years; (iii) had chronic pain for >3 months, and; (iv) had been stable on oral pain medications for the preceding 2 weeks. Participants were allowed to continue their pain medication at the prescribed dose and frequency.…”

“…In the BreEStim treatment (see details in (23)), human voluntary breathing triggers an external electrical stimulator (sham or active) to the current dominant primary motor cortex (M1), followed by a 20-min BreEStim to the median nerve (160 times) transcutaneously on the current dominant side. Each combined intervention was given at least 3 days apart in a randomized order (33). Ten participants completed both active and sham tDCS sessions, while, due to scheduling issues, the remaining 2 participants only completed active tDCS sessions.…”

“…The previous BreEStim protocol (30,33) was used in this study. Briefly, participants wore a facemask connected to a Pneumotach system to record breathing signals.…”

“…the affective response to the same stimuli, or de-sensitization. In a previous study we found that patients with SCI who have chronic neuropathic pain demonstrate significant analgesic effects after receiving BreEStim treatment (33).…”