Habituation to Experimentally Induced Electrical Pain during Voluntary-Breathing Controlled Electrical Stimulation (BreEStim)

Abstract

ObjectivePainful peripheral electrical stimulation to acupuncture points was found to cause sensitization if delivered randomly (EStim), but induced habituation if triggered by voluntary breathing (BreEStim). The objective was to systematically compare the effectiveness of BreEStim and EStim and to investigate the possible mechanisms mediating the habituation effect of BreEStim.MethodsEleven pain-free, healthy subjects (6 males, 5 females) participated in the study. Each subject received the BreEStim and EStim treatments in a random order at least three days apart. Both treatments consisted of 120 painful but tolerable stimuli to the ulnar nerve at the elbow on the dominant arm. BreEStim was triggered by voluntary breathing while EStim was delivered randomly. Electrical sensation threshold (EST) and electrical pain threshold (EPT) were measured from the thenar and hypothenar eminences on both hands at pre-intervention and 10-minutes post-intervention.ResultsThere was no difference in the pre-intervention baseline measurement of EST and EPT between BreEStim and EStim. BreEStim increased EPT in all tested sites on both hands, while EStim increased EPT in the dominant hypothenar eminence distal to the stimulating site and had no effect on EPT in other sites. There was no difference in the intensity of electrical stimulation between EStim and BreEStim.ConclusionOur findings support the important role human voluntary breathing plays in the systemic habituation effect of BreEStim to peripheral painful electrical stimulation.

Tactile, thermal, and electrical thresholds in patients with and without phantom limb pain after traumatic lower limb amputation

“…The finding of selective modulation of EPT was also consistent with our recent studies. 19 , 20 We found that EPT was significantly increased after breathing-controlled electrical stimulation (BreEStim), but it was significantly decreased after standard electrical stimulation without changes in TSTs, thermal thresholds, and EST. These studies suggest habituation to experimentally induced pain after BreEStim, but sensitization after standard electrical stimulation.…”

“… 21 Furthermore, decrease in EPT has been viewed to reflect central sensitization. 18 – 20 The primary significant finding of decreased EPT in the sound limb in the PLP group with no significant difference in other sensory thresholds between two groups suggests central sensitization as a possible mechanism mediating PLP. The finding of selective modulation of EPT was also consistent with our recent studies.…”

“…Electrical-pain threshold has been used to reflect central sensitization. 18 – 20 It was hypothesized that electrical thresholds would be lower in subjects with PLP than in those without PLP after traumatic injury, ie, central sensitization, and that there would be no difference in thermal and mechanical thresholds.…”

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

“…BreEStim has been shown to increase the pain threshold, without affecting the sensory perception threshold, in a number of studies (30)(31)(32). As such, BreEStim provides central de-sensitization effects and thus analgesic effects for chronic neuropathic pain after SCI (33,45) and amputation (45).…”

“…There are currently no effective pharmacological treatments for *An abstract of this paper was presented as a scientific paper at the Association of Academic Physiatrists (AAP) Annual Meeting, Atlanta, GA, USA, during February 14-17, 2018. that delivers a single pulse of electrical stimulation to a peripheral nerve, such as the median, ulnar, or radial nerve. Following BreEStim treatment on one side, pain thresholds increased without change in sensation thresholds in both the treatment and contralateral sides in pain-free healthy participants (30)(31)(32). Therefore, the BreEStim mechanism is postulated to occur at the central level, modifying how participants react to the noxious stimuli, i.e.…”