Neuropathic pain modulation after spinal cord injury by breathing-controlled electrical stimulation (BreEStim) is associated with restoration of autonomic dysfunction

Journal of Pain Research, 2018 · DOI: http://dx.doi.org/10.2147/JPR.S174475 · Published: January 1, 2018

Spinal Cord Injury Neurology Pain Management

Simple Explanation

This study investigates how breathing-controlled electrical stimulation (BreEStim) affects neuropathic pain (NP) and autonomic function in people with spinal cord injury (SCI). The study aims to understand the mechanisms behind pain and autonomic changes by measuring heart rate variability (HRV). The researchers administered both null and active BreEStim interventions to SCI+NP subjects. They collected HRV data and pain scores before and after the interventions, comparing them to SCI–NP subjects. The results showed that active BreEStim increased HRV and reduced pain scores in SCI+NP subjects, suggesting a restoration of autonomic function. The findings suggest that BreEStim can help restore autonomic dysfunction associated with neuropathic pain after SCI. This indicates a strong connection between pain modulation and autonomic function, offering a potential treatment approach for managing NP in SCI populations.

Study Duration

Not specified

Participants

SCI+NP subjects (n=10) and SCI–NP subjects (n=11)

Evidence Level

Not specified

Key Findings

1
SCI+NP subjects had lower baseline HRV compared to SCI–NP subjects.
2
Active BreEStim increased HRV and parasympathetic tone in SCI+NP subjects, as measured by NN50 and pNN50 parameters.
3
After active BreEStim, the autonomic profile of the SCI+NP group became comparable to the SCI–NP group.

Research Summary

This study explored the modulation of chronic neuropathic pain (NP) following spinal cord injury (SCI) using breathing-controlled electrical stimulation (BreEStim) and measured changes in heart rate variability (HRV) to capture autonomic responses. The results indicated that active BreEStim led to an increase in HRV and parasympathetic tone in SCI+NP subjects, along with lower VAS scores, suggesting a restoration of autonomic function. The study concludes that centrally delivered analgesia via BreEStim is associated with autonomic restoration in persons with chronic NP and SCI, supporting the interconnectedness between the pain neuromatrix (PNM) and the central autonomic network (CAN).

Practical Implications

Therapeutic Intervention

BreEStim can be used as a non-pharmacological intervention to manage neuropathic pain in individuals with spinal cord injuries.

Diagnostic Tool

HRV can be used as a modality for diagnosing neuropathic pain after spinal cord injury.

Understanding Pathophysiology

The study provides further evidence of the interconnectedness between the pain neuromatrix and the central autonomic network in modulating chronic NP following SCI.

Study Limitations

1
Small sample size limited further analyses exploring the impact of the neurological level of injury on HRV modulations after intervention.
2
The study utilized a 5-minute ECG approach for HRV analysis, which may not be as sensitive as longer recordings for frequency domain parameters.
3
Restoration of autonomic dysfunction was observed concomitantly with analgesic effects after only one session of BreEStim treatment, and the long-term effects of sustained treatment are unknown.

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