Breathing-controlled Electrical Stimulation (BreEStim) for Management of Neuropathic Pain and Spasticity

Abstract

Electrical stimulation (EStim) refers to the application of electrical current to muscles or nerves in order to achieve functional and therapeutic goals. It has been extensively used in various clinical settings. Based upon recent discoveries related to the systemic effects of voluntary breathing and intrinsic physiological interactions among systems during voluntary breathing, a new EStim protocol, Breathing-controlled Electrical Stimulation (BreEStim), has been developed to augment the effects of electrical stimulation. In BreEStim, a single-pulse electrical stimulus is triggered and delivered to the target area when the airflow rate of an isolated voluntary inspiration reaches the threshold. BreEStim integrates intrinsic physiological interactions that are activated during voluntary breathing and has demonstrated excellent clinical efficacy. Two representative applications of BreEStim are reported with detailed protocols: management of post-stroke finger flexor spasticity and neuropathic pain in spinal cord injury.

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

“…We observed that BreEStim resulted in a general desensitization effect (measured by elevated electrical pain thresholds in both treated and nontreated hands), while there was no such effect, or even a general sensitization effect after EStim or voluntary breathing only 17–19. The findings support preliminary clinical observations15,16 that BreEStim-induced analgesia is likely related to modification of the affective component, ie, central effect. This effect has been attributed to internal pain-coping mechanisms activated by EStim during the specific window of voluntary breathing 16…”

“…The delivery is triggered by fast and deep voluntary inhalation. In recent case reports,15,16 we have shown that BreEStim is effective in reducing chronic neuropathic pain in people with paraplegia and above-the-knee amputation. In these cases, BreEStim was applied only to the median nerve in the arm.…”

“…Technical details of BreEStim are available online in a methodology video article: http://www.jove.com/video/50077/ 15…”

“…Breathing-controlled electrical stimulation (BreEStim) is a recently developed, novel, nonpharmacological intervention for neuropathic pain management 15. Briefly, in the BreEStim treatment, single-pulse electrical stimulation (EStim) is delivered transcutaneously to a peripheral nerve.…”

“…It is thus theoretically possible that the sensory and affective components of neuropathic pain could be modulated separately for therapeutic purposes. For example, BreEStim is shown to relieve pain by selectively affecting the affective component of neuropathic pain 15,16…”