Bedside neuromodulation of persistent pain and allodynia using caloric vestibular stimulation: an effectiveness trial

Ngo, Trung Thanh; Barsdell, W. N.; Arnold, Carolyn; Chou, Michael; New, Peter W; Hill, Susan T.; Nunn, Andrew; Brown, Douglas J.; Gibson, Stephen; Miller, Steven M.

doi:10.1016/j.jns.2015.08.304

Cited by 7 publications

(9 citation statements)

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“…However, given spinal cord stimulation is invasive and expensive there should be a focus on emerging non-invasive, inexpensive neuromodulation techniques. One such technique (vestibular neuromodulation) being examined by this author: (i) shows promising preliminary clinical results in modulating pain and allodynia; (ii) activates PP-relevant cortical regions (ACC, AIC, S2) 3 ; and (iii) modulates belief, cognition, and psychiatric dysfunction (Miller and Ngo, 2007; Ngo et al, 2015; Miller, 2016; Ngo et al, in preparation). Whatever procedural interventions are required, if any, the OPM MoC principles apply throughout planning for and after such interventions.…”

Section: Occupational Pain Medicine: a Model Of Care For Preventing Amentioning

confidence: 99%

Occupational Pain Medicine: From Paradigm Shift in Pain Neuroscience to Contextual Model of Care

Miller

2019

Front. Hum. Neurosci.

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Section: Occupational Pain Medicine: a Model Of Care For Preventing Amentioning

confidence: 99%

Occupational Pain Medicine: From Paradigm Shift in Pain Neuroscience to Contextual Model of Care

Miller

2019

Front. Hum. Neurosci.

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“…Similar CVS methods applied in healthy volunteers were able to reduce both subjective pain sensation and nociceptive laser-evoked potentials [28,29]. However, CVS performed by administrating cold/warm water into the external ear canal can in a proportion of patients trigger undesirable effects such as nausea and vomiting [21,26,30,31]. This may limit its use in some patients even if it attenuates their pain [21], although the majority of pain patients would likely be more tolerant of the transient unpleasant effects than dizziness patients who undergo CVS as a diagnostic procedure (e.g.…”

Section: Introductionmentioning

confidence: 99%

“…Ramachandran et al [19] introduced the concept that vestibular activation is theoretically able to reduce pain by interfering with nociceptive afferents at their arrival to the posterior insula. Indeed, there exists overlap between the posterior insular sectors where direct insular stimulation in humans can elicit vestibular and nociceptive responses [17], and prior studies using CVS have reported pain relief in several clinical pain conditions, including post-stroke pain [19e22], phantom limb pain [23], spinal cord lesions [24,25], complex regional pain syndrome [26] and migraine [27]. Similar CVS methods applied in healthy volunteers were able to reduce both subjective pain sensation and nociceptive laser-evoked potentials [28,29].…”

Section: Introductionmentioning

confidence: 99%

Cortical modulation of nociception by galvanic vestibular stimulation: A potential clinical tool?

et al. 2020

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Objective: Vestibular afferents converge with nociceptive ones within the posterior insula, and can therefore modulate nociception. Consistent with this hypothesis, caloric vestibular stimulation (CVS) has been shown to reduce experimental and clinical pain. Since CVS can induce undesirable effects in a proportion of patients, here we explored an alternative means to activate non-invasively the vestibular pathways using innocuous bi-mastoid galvanic stimulation (GVS), and assessed its effects on experimental pain. Methods: Sixteen healthy volunteers participated in this study. Experimental pain was induced by noxious laser-heat stimuli to the left hand while recording pain ratings and related brain potentials (LEPs). We evaluated changes of these indices during left-or right-anodal GVS (cathode on contralateral mastoid), and contrasted them with those during sham GVS, optokinetic vestibular stimulation (OKS) using virtual reality, and attentional distraction to ascertain the vestibular-specific analgesic effects of GVS. Results: GVS elicited brief sensations of head/trunk deviation, inoffensive to all participants. Both active GVS conditions showed analgesic effects, greater for the right anodal stimulation. OKS was helpful to attain significant LEP reductions during the left-anodal stimulation. Neither sham-GVS nor the distraction task were able to modulate significantly pain ratings or LEPs. Conclusions: GVS appeared as a well-tolerated and powerful procedure for the relief of experimental pain, probably through physiological interaction within insular nociceptive networks. Either isolated or in combination with other types of vestibular activation (e.g., optokinetic stimuli), GVS deserves being tested in clinical settings.

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“…In a group of 10 patients with phantom limb pain, caloric vestibular stimulation was related to pain reduction in all of them (24). In patients with a variety of pain conditions including phantom limb pain, spinal cord injury and complex regional pain, a significant analgesic effect was observed after cold caloric vestibular stimulation, compared to a control stimulation (ice-pack to forehead) (32).…”

Section: Introductionmentioning

confidence: 99%

Stimulation of the Semicircular Canals or the Utricles by Clinical Tests Can Modify the Intensity of Phantom Limb Pain

et al. 2019

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Background: After amputation, phantom limb pain may be produced by the multisensory processes underling the experience of an intact body. Clinical evidence has shown that cold caloric vestibular stimulation may modify the perception of phantom limb pain. However, it is yet unknown if this effect can be observed after the mild vestibular stimulation given by the clinical caloric test, or after utricle stimulation by centrifugation. Additionally, there are no studies on the association between the report of altered perceptions or experience of the self or the environment (depersonalization/derealization symptoms) and phantom limb pain. Objective: To assess the influence of unilateral stimulation of the horizontal semicircular canals by clinical caloric test, and the utricles by unilateral centrifugation on the intensity of phantom limb pain, and to explore the association between phantom limb pain and symptoms of depersonalization/ derealization. Methods: 34 patients (56 ±7 years old, 23 men) accepted to participate after 3 to 23 months of unilateral supracondylar amputation, secondary to type 2 diabetes mellitus. After assessment of vestibular function and symptoms of common mental disorders, using a cross-over design, in 2 separate sessions with 1 week in between, vestibular stimulation was delivered by right/left caloric test (30 or 44°C) or right/ left centrifugation (3.85 cm, 300°/s peak). Before and after each vestibular stimulus, the intensity of phantom limb pain and depersonalization/derealization symptoms were assessed, with a daily follow-up of pain intensity during 1 week. Results: Either caloric stimulation or unilateral centrifugation decreased phantom limb pain ( p < 0.05), along with decrease of symptoms of depersonalization/derealization ( p < 0.05). One third of the patients reporting pain decrease immediately after stimulation also reported no pain at least for 1 day. Limitations: No sham condition was included. Conclusions: Vestibular stimulation by the clinical caloric tests or by unilateral centrifugation may decrease the intensity of phantom limb pain, with decrease of perceptions of unreality. These effects might be related to an update of the immediate experience of the body, given by the sensory mismatch induced by asymmetrical vestibular stimulation.

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Bedside neuromodulation of persistent pain and allodynia using caloric vestibular stimulation: an effectiveness trial

Cited by 7 publications

References 0 publications

Occupational Pain Medicine: From Paradigm Shift in Pain Neuroscience to Contextual Model of Care

Occupational Pain Medicine: From Paradigm Shift in Pain Neuroscience to Contextual Model of Care

Cortical modulation of nociception by galvanic vestibular stimulation: A potential clinical tool?

Stimulation of the Semicircular Canals or the Utricles by Clinical Tests Can Modify the Intensity of Phantom Limb Pain

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