Neuromodulation in chronic pain management: addressing persistent doubts in spinal cord stimulation

Journal of Anesthesia Analgesia and Critical Care, Journal Year: 2025, Volume and Issue: 5(1)

Published: Jan. 6, 2025

Language: Английский

---

Pain and the autonomic nervous system. The role of non-invasive neuromodulation with NESA microcurrents

Frontiers in Pain Research, Journal Year: 2025, Volume and Issue: 6

Published: Feb. 17, 2025

Human pain is a complex and multifaceted phenomenon(1) that controlled by multiple systems in the human body (2). These work together to process, interpret respond (3).The International Association for Study of Pain defines as "an unpleasant sensory emotional experience associated with, or resembling actual potential tissue damage" (4) This evokes an integrated response from various with pain.This phenomenon occurs more way at level cortex where consciously perceived, such primary somatosensory cortex, motor supplementary secondary insular anterior cingulate thalamus (5,6). Also unconscious level, but central, regulation pain, which linked limbic system, acquires individual component emotions experiences themselves, memory fear amygdala, hippocampus subcortical structures, including basal ganglia (6,7).In addition, there are some particularly important regulation, namely immunological endocrine system descending noradrenergic system. Despite today's deeper understanding mechanisms, still lack solutions conditions. The role autonomic nervous (ANS) modulation different involved becoming increasingly clear urgent need develop effective ANS focus on (9). From this perspective, neuromodulation appears be potentially supportive solution particular non-invasive NESA, has been shown chronic pathologies sclerosis (8).The arises non-pharmacological treatments, based electrical neuromodulation, backed scientific evidence support their use pain. In sense, previous studies have microcurrent technologies prefrontal transcranial stimulation (tDCS) combined peripheral (9) vagal stimulators (VNS) (10) demonstrated benefits aspects headaches, diverse populations (11). However, science advancing other types specific emerging targets comfortable patient, no side effects easier application, NESA (12). It therefore necessary explore field microcurrents so they can used modulate through system.Subsections relevant subject.The immune influences release substances pro-inflammatory cytokines, sensitize receptors pathways thus increase perception (13). also plays reducing levels process recovery (14). inflammation largely mediated its divisions sympathetic, parasympathetic enteric branches (15). deregulation observed autoimmune diseases rheumatoid arthritis, systemic lupus erythematosus sclerosis, changes increased inflammation. As result these inflammatory levels, dysfunctional interaction between gut microbiota direct homeostasis (14,15). A study individuals arthritis showed strong correlation sympathetic activity due muscle nerve painful symptoms patients (16).The influence via hormones (17,18). hypothalamic-pituitary-adrenal axis (HPA axis) cortisol hormonal regulatory great importance regulating levels. Elevated following acute stress facilitate consolidation fearbased memories cause sensitized physiological stress. prolonged situations constant exaggerated physical neuroendocrine activity, decrease perpetuate generalized (19). accompanied adrenaline stress, transiently alter type often "fight flight" response, temporarily reduce sensitivity (20). leads functional change impairs fibromyalgia (21,22) central sensitization (23).Pain depends relationship periaqueductal gray matter (PAG) reticular formation brainstem (24). PAG risk assessment threat contributes defensive behaviors related negative events. lead learned aversive involvement responses, responses characteristic (25). Some structures development maintenance allodynia hyperalgesia damage, neurons locus coeruleus terminals dorsal nucleus, medial horn spinal cord caudal trigeminal nucleus (26).The brainstem, nuclei serotonergic raphe, play fundamental sleep ANS. Wakefulness characterized engagement external environment. Accordingly, consistent remodulation during transition wakefulness (27). Recent qualitative analyzes longitudinal micro-longitudinal suggest stronger unidirectional effect exacerbation adult patients, experimental models (28)(29)(30)(31)(32). For example, it deprivation elicit hyperalgesic (i.e., abnormally sensitivity) healthy correlate electrophysiologic measures (e.g., decreases laser-evoked potentials) (33) reversed nap short regardless vigilance status (34).The clearer mechanisms action deepen. Although main function not directly regulate activating (35,36). increases respiratory rate, tension, electrodermal dilates pupils (37). Similarly, activation vagus reflex (38)(39)(40). At link low frequencies heart rate variability brain connectivity areas (41).The mixed consisting sensory, fibers contains approximately 80% afferent 20% efferent (42). Of three belonging nerve, (myelinated) B (preganglionic innervation), unmyelinated C (which make up about 70% all fibers) responsible transmission visceral information organs, modulating produced (43,44). Due approaches treatment considered, divided into invasive methods. latter prevailed because convenient involve fewer risks handling consequently clinical complications (10,45).Although extremely just another part truly global Therefore, allow restore normal modulation.The modern era began publication Benabid et al. 1987, deep was suppress tremor Parkinson's disease (46). electricity treat neurological disorders dates back earliest antiquity (47). early 1st century BC, physician Scribonius Largus recommended shocks torpedo fish marmorata Emperor Claudius his headaches ailments (48). Advances neuroimaging advent magnetic resonance imaging imaging, improved surgical techniques, contributed significant techniques greater precision application (49). better neural circuitry neurological, psychiatric, cognitive behavioral led expansion considerable number (50,51).Especially invasive, minimally noninvasive methods, stimulation. procedures, interventions presented first choice management (52,53). Until few years ago, two were known researched: (54)(55)(56)(57) generators being investigated. proven successful frequently therapeutic tool centers specializing (58)(59)(60). vast majority devices applied locally, limitation polyarticular Nowadays, most studied traditional (non-invasive) tDCS, (9,10). both transcutaneously, neither focuses specifically modulation. On hand, cover only one input target, peripheral. go step further. capacity (central peripheral). means modulatory actions orthodromic impulses activate inhibitory pathways, neuromodulatory neurotransmitters, finally generated systemically using control (56,61,62).Non-invasive superficial (50), sensations very patient. electric multiplied delivered several structurally whole body, electrodes limbs directing electrode. technique coordinated over 24 modulates ultra-low frequency signals. characteristics current emission low-frequency pulses oscillating 1.4 Hz 14.28 (depending program), pulse intensity 0.1-0.9 milliamperes difference ±3 V, coordination simultaneously. format distributed sequences (between 100 130 msg) each program biphasic monophasic alternations intervals polarities duration program. local activation, parameters operate utilizing semielectrodes, effectively circulating current, while remaining solely body's surface. across semi-electrodes (six per limb globes wrist anklets ankles) simultaneously stimulated, resultant rather than localized area, owing nature electrode placement (see figure 1) times set hour. dependent profesional´s reasoning patient's necessity. Exist protocols twice (64), (63,65) treatment, what least 10 sessions (63)(64)(65). considered middle-long order If course favorable, carried out longer frequently, always depending (12).The technology may useful high-level players optimize content exercise stressors (64). safe children, any adverse registered, easy apply shows clinically results constipation (63) sleepiness dementia (65) well promising diseases. line findings, recent explored new possibilities quality sclerosis(8), positive reduction quality. published authors describe recorded, probably usually patient-friendly treatment. Based results, trials currently conducted others fybromialgia sindrome (clinical trial registration NCT05648695), stroke sequeales NCT058539529), long covid NCT056814559), after surgery NCT05207943) even regional syndrome (Sudeck) NCT05052736).Although future research needs variety settings larger sample sizes, comparing groups technology. could demonstrate perspective targeting There do interesting practice initiated view treating Perhaps help us approach management.

Language: Английский

---

Electro-spun piezoelectric PLLA smart composites as a scaffold on bone fracture: A review

Regenerative Therapy, Journal Year: 2025, Volume and Issue: 28, P. 591 - 605

Published: Feb. 20, 2025

Language: Английский

---

Neuropathic pain, antidepressant drugs, and inflammation: a narrative review

Journal of Anesthesia Analgesia and Critical Care, Journal Year: 2024, Volume and Issue: 4(1)

Published: Sept. 27, 2024

Language: Английский

---

Efficacy of indirect intense pulsed light irradiation on meibomian gland dysfunction: a randomized controlled study

International Journal of Ophthalmology, Journal Year: 2024, Volume and Issue: 17(11), P. 2014 - 2022

Published: Oct. 23, 2024

AIM: To investigate the efficacy and mechanisms of indirect intense pulsed light (IPL) irradiation on meibomian gland dysfunction (MGD). METHODS: A total 60 MGD patients was included in this prospective randomized controlled trial. Patients were randomly assigned 1:1 into two groups (3-mm group 10-mm group) which IPL applied at distances from lower eyelid margin 3 10 mm, respectively. Both received three times treatment with 3-week interval. Meibomian yield secretion score (MGYSS), standard patient evaluation eye dryness (SPEED) questionnaire, tear break-up time (TBUT), corneal fluorescein staining (CFS), vivo confocal microscopy performed baseline after every treatment. RESULTS: After treatments, both had significant improvement MGYSS (both P<0.05). The non-inferiority test showed that not inferior to 3-mm (P<0.001). In groups, temporal regions upper eyelids MGYSS. Scores SPEED questionnaire declined significantly P<0.001) changes no difference between (P=0.57). Density central subepithelial nerves TBUTs statistically changes. (P=0.048) morphology (acini wall thickness P=0.003, hyperreflective points P=0.024) while not. CONCLUSION: improving alleviating dry symptoms remains unchanged increase distance. may primarily act functional glands nerves.

Language: Английский

---