Chronic pain and spinal cord stimulation

Corallo, Francesco; Salvo, Simona De; Cannistraci, Cecilia; Buono, Viviana Lo; Cara, Marcella Di; Floridia, Daniela; Cerra, Francesco; Romeo, Laura; Pria, Deborah; Bramantı, Placido; Marıno, Silvia

doi:10.1097/md.0000000000020490

Cited by 4 publications

(3 citation statements)

References 42 publications

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“…Personalized neurostimulation therapies, where targeted electrical stimulation is delivered to the nervous system based on an individual's physiological or behavioral state, have gained prominence in recent years as a potential treatment for numerous nervous system disorders (Olofsson and Tracey 2017, Peng et al 2018, Sisterson et al 2019, Figee and Mayberg 2021. Traditionally, neurostimulation devices for pain (Grider et al 2016, Kapural et al 2016, Corallo et al 2020. However, using patient-specific information as feedback to modulate stimulation, referred to as closed-loop stimulation, can optimize therapy and improve patient outcomes (Meidahl et al 2017, Peng et al 2018, Swann et al 2018, Figee and Mayberg 2021.…”

Section: Introductionmentioning

confidence: 99%

Closed-loop automated reaching apparatus (CLARA) for interrogating complex motor behaviors

et al. 2021

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Objective. Closed-loop neuromodulation technology is a rapidly expanding category of therapeutics for a broad range of indications. Development of these innovative neurological devices requires high-throughput systems for closed-loop stimulation of model organisms, while monitoring physiological signals and complex, naturalistic behaviors. To address this need, we developed CLARA, a closed-loop automated reaching apparatus. Approach. Using breakthroughs in computer vision, CLARA integrates fully-automated, markerless kinematic tracking of multiple features to classify animal behavior and precisely deliver neural stimulation based on behavioral outcomes. CLARA is compatible with advanced neurophysiological tools, enabling the testing of neurostimulation devices and identification of novel neurological biomarkers. Results. The CLARA system tracks unconstrained skilled reach behavior in 3D at 150 Hz without physical markers. The system fully automates trial initiation and pellet delivery and is capable of accurately delivering stimulation in response to trial outcome with short latency. Kinematic data from the CLARA system provided novel insights into the dynamics of reach consistency over the course of learning, suggesting that learning selectively improves reach failures but does not alter the kinematics of successful reaches. Additionally, using the closed-loop capabilities of CLARA, we demonstrate that vagus nerve stimulation (VNS) improves skilled reach performance and increases reach trajectory consistency in healthy animals. Significance. The CLARA system is the first mouse behavior apparatus that uses markerless pose tracking to provide real-time closed-loop stimulation in response to the outcome of an unconstrained motor task. Additionally, we demonstrate that the CLARA system was essential for our investigating the role of closed-loop VNS stimulation on motor performance in healthy animals. This approach has high translational relevance for developing neurostimulation technology based on complex human behavior.

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Section: Introductionmentioning

confidence: 99%

Closed-loop automated reaching apparatus (CLARA) for interrogating complex motor behaviors

et al. 2021

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“…Traditionally, neurostimulation devices in the clinic have applied open-loop modulation, where stimulation is applied continuously and not altered on the basis of the individual’s state or behavior. These include deep brain stimulation devices for Parkinson’s Disease and Essential Tremor (Benabid et al, 1991, 2009; Kumar et al, 1998; Blomstedt et al, 2010; Cury et al, 2017), Vagus nerve stimulation (VNS) for epilepsy and medically intractable depression (Schachter, 2002; Howland, 2014; Carreno and Frazer, 2017), and spinal cord stimulation (SCS) for pain (Grider et al, 2016; Kapural et al, 2016; Corallo et al, 2020). However, using patient-specific information as feedback to modulate electrical stimulation can optimize therapy and improve patient outcomes (Meidahl et al, 2017; Peng et al, 2018; Swann et al, 2018; Figee and Mayberg, 2021).…”

Section: Introductionmentioning

confidence: 99%

Closed-loop automated reaching apparatus (CLARA) for interrogating motor systems

Bowles

Williamson

Nettles

et al. 2021

Preprint

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Objective: Personalized neurostimulation is a rapidly expanding category of therapeutics for a broad range of indications. Development of these innovative neurological devices requires high-throughput systems for closed-loop stimulation of model organisms, while monitoring physiological signals and complex, naturalistic behaviors. To address this need, we developed CLARA, a closed-loop automated reaching apparatus. Approach: Using breakthroughs in computer vision, CLARA integrates fully-automated, markerless kinematic tracking of multiple features we use to classify animal behavior and precisely deliver neural stimulation based on behavioral outcomes. CLARA is compatible with advanced neurophysiological tools, enabling the testing of neurostimulation devices and identification of novel neurological biomarkers. Results: The CLARA system tracks unconstrained skilled reach behavior in 3D at 150hz without physical markers. The system fully automates trial initiation and pellet delivery and is capable of accurately delivering stimulation in response to trial outcome with sub-quarter second latency. Mice perform the skilled reach task in the CLARA system at a proficiency similar to manually trained animals. Kinematic data from the CLARA system provided novel insights into the dynamics of reach consistency over the course of learning, suggesting that changes are driven entirely by unsuccessful reach accuracy. Additionally, using the closed-loop capabilities of CLARA, we demonstrate that vagus nerve stimulation (VNS) delivered on reach success improves skilled reach performance and increases reach trajectory consistency in healthy animals. Significance: The CLARA system is the first mouse behavior apparatus that uses markerless pose tracking to provide real-time closed-loop stimulation in response to the outcome of an unconstrained motor task. Additionally, we demonstrate that the CLARA system was essential for our finding that VNS given after successful completion of a motor task improves performance in healthy animals. This approach has high translational relevance for developing neurostimulation technology based on complex human behavior.

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“…In many patients with failed back surgery syndrome (FBSS), the origin of the persisting element in the pain experience is still unknown, which makes targeted treatment difficult to deliver [1,2]. Spinal cord stimulation (SCS) is a well-known treatment option for therapyrefractory FBSS, with pain-relieving effects as well as positive effects on quality of life, exercise capacity, anxiety, and depression [3][4][5][6][7][8][9]. Nevertheless, the exact mechanisms of SCS are not yet fully understood [10].…”

Section: Introductionmentioning

confidence: 99%

Electrochemical Skin Conductance Alterations during Spinal Cord Stimulation: An Experimental Study

Goudman

Vets

Jansen

et al. 2021

JCM

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Despite the well-known clinical effects of spinal cord stimulation (SCS), the mechanisms of action have not yet been fully unraveled. The primary aim of this study was to measure whether electrochemical skin conductance, as a measure of peripheral sympathetic autonomic function, is altered by SCS. A second aim was to compare skin conductance levels of patients with failed back surgery syndrome (FBSS) with age- and sex-matched healthy controls. Twenty-three patients with FBSS treated with SCS participated in this study. Sudomotor function was measured with the SudoscanTM instrument on the hands and feet during SCS on and off states. Difference scores in skin conductance between patients and age- and sex-matched healthy controls were calculated. Normal sudomotor function at the painful lower limb was revealed for 61% of the patients when SCS was activated. Skin conductance levels were not altered between on and off states of SCS. Differences in scores between patients and healthy controls were significantly different from zero. This study showed that SCS does not influencing the sympathetic nervous system in patients with FBSS, as measured by skin conductance levels. Moreover, it suggested that there is no normalization of the functioning of the sympathetic nervous system, despite the effectiveness of SCS to reduce pain intensity.

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Chronic pain and spinal cord stimulation

Cited by 4 publications

References 42 publications

Closed-loop automated reaching apparatus (CLARA) for interrogating complex motor behaviors

Closed-loop automated reaching apparatus (CLARA) for interrogating complex motor behaviors

Closed-loop automated reaching apparatus (CLARA) for interrogating motor systems

Electrochemical Skin Conductance Alterations during Spinal Cord Stimulation: An Experimental Study

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