Neuromodulation in pain
<p>Background</p> <p>Chronic pain is one of the most debilitating disorders afflicting a wide cross-section of the global population. Unfortunately, conventional treatments for chronic pain have proven ineffective for a large subsection of this patient population, prompting the de...
| Main Author: | |
|---|---|
| Other Authors: | |
| Format: | Thesis |
| Language: | English |
| Published: |
2020
|
| _version_ | 1826316012410109952 |
|---|---|
| author | Parker, TOA |
| author2 | Aziz, T |
| author_facet | Aziz, T Parker, TOA |
| author_sort | Parker, TOA |
| collection | OXFORD |
| description | <p>Background</p>
<p>Chronic pain is one of the most debilitating disorders afflicting a wide cross-section of the global population. Unfortunately, conventional treatments for chronic pain have proven ineffective for a large subsection of this patient population, prompting the development of new therapeutic paradigms such as neuromodulation. Deep brain stimulation, dorsal root ganglion stimulation and non-invasive brain stimulation have emerged as useful tools in the therapeutic armamentarium for these medically refractory chronic pain patients. We sought to interrogate how these treatments might work and what insights can be gained into the neurophysiology of the pain experience through neuromodulation.</p>
<p>Methods</p>
<p>This thesis describes three categories of experiments into the neurophysiology of chronic pain. The first explored the mechanisms of dorsal root ganglion stimulation in the sensory, cognitive and affective dimensions of pain, as well as its potential to modulate the autonomic nervous system. The second interrogated the utility of non-invasive brain stimulation, transcranial direct current stimulation, to augment the supraspinal effects of dorsal root ganglion stimulation. The final experiment involved a retrospective analysis regarding the effectiveness stimulation frequency in deep brain stimulation for chronic pain and whether these treatments are dependent on underlying neural activity.</p>
<p>Results</p>
<p>1. There were significant neurophysiologic markers of pain (cortical theta activity) and pain relief (cortical beta activity) among dorsal root ganglion stimulation patients, with efficacy in modulating sensory, cognitive and autonomic indicators in chronic pain patients. The affective dimension of 3 pain revealed mixed results, however demonstrated features consistent with differences of emotional processing in chronic pain compared to healthy controls.</p>
<p>2. Transcranial direct current stimulation significantly enhanced the therapeutic efficacy of dorsal root ganglion stimulation on chronic pain in the acute setting and demonstrated augmentation of predetermined neurophysiologic indicators (cortical beta activity) of pain relief.</p>
<p>3. The efficacy of deep brain stimulation did not appear to be dependent on stimulation frequency. However, baseline local field potential recordings appear to be predictive of the ideal stimulation frequency to optimise analgesic effect in chronic pain patients.</p>
<p>Conclusion</p>
<p>This thesis provides novel evidence of the mechanisms of dorsal root ganglion stimulation and provides preliminary evidence of a synergistic effect between invasive and non-invasive neuromodulation in the treatment of chronic pain. We have also provided supportive evidence for the utility of physiologic biomarkers of pain in evaluating neuromodulatory therapies as a framework for personalising chronic pain treatments.</p> |
| first_indexed | 2024-03-06T20:07:51Z |
| format | Thesis |
| id | oxford-uuid:2984f121-a275-44e3-b9bb-bba64b2266ec |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-12-09T03:36:50Z |
| publishDate | 2020 |
| record_format | dspace |
| spelling | oxford-uuid:2984f121-a275-44e3-b9bb-bba64b2266ec2024-12-01T20:08:43ZNeuromodulation in painThesishttp://purl.org/coar/resource_type/c_db06uuid:2984f121-a275-44e3-b9bb-bba64b2266ecEnglishHyrax Deposit2020Parker, TOAAziz, TGreen, A<p>Background</p> <p>Chronic pain is one of the most debilitating disorders afflicting a wide cross-section of the global population. Unfortunately, conventional treatments for chronic pain have proven ineffective for a large subsection of this patient population, prompting the development of new therapeutic paradigms such as neuromodulation. Deep brain stimulation, dorsal root ganglion stimulation and non-invasive brain stimulation have emerged as useful tools in the therapeutic armamentarium for these medically refractory chronic pain patients. We sought to interrogate how these treatments might work and what insights can be gained into the neurophysiology of the pain experience through neuromodulation.</p> <p>Methods</p> <p>This thesis describes three categories of experiments into the neurophysiology of chronic pain. The first explored the mechanisms of dorsal root ganglion stimulation in the sensory, cognitive and affective dimensions of pain, as well as its potential to modulate the autonomic nervous system. The second interrogated the utility of non-invasive brain stimulation, transcranial direct current stimulation, to augment the supraspinal effects of dorsal root ganglion stimulation. The final experiment involved a retrospective analysis regarding the effectiveness stimulation frequency in deep brain stimulation for chronic pain and whether these treatments are dependent on underlying neural activity.</p> <p>Results</p> <p>1. There were significant neurophysiologic markers of pain (cortical theta activity) and pain relief (cortical beta activity) among dorsal root ganglion stimulation patients, with efficacy in modulating sensory, cognitive and autonomic indicators in chronic pain patients. The affective dimension of 3 pain revealed mixed results, however demonstrated features consistent with differences of emotional processing in chronic pain compared to healthy controls.</p> <p>2. Transcranial direct current stimulation significantly enhanced the therapeutic efficacy of dorsal root ganglion stimulation on chronic pain in the acute setting and demonstrated augmentation of predetermined neurophysiologic indicators (cortical beta activity) of pain relief.</p> <p>3. The efficacy of deep brain stimulation did not appear to be dependent on stimulation frequency. However, baseline local field potential recordings appear to be predictive of the ideal stimulation frequency to optimise analgesic effect in chronic pain patients.</p> <p>Conclusion</p> <p>This thesis provides novel evidence of the mechanisms of dorsal root ganglion stimulation and provides preliminary evidence of a synergistic effect between invasive and non-invasive neuromodulation in the treatment of chronic pain. We have also provided supportive evidence for the utility of physiologic biomarkers of pain in evaluating neuromodulatory therapies as a framework for personalising chronic pain treatments.</p> |
| spellingShingle | Parker, TOA Neuromodulation in pain |
| title | Neuromodulation in pain |
| title_full | Neuromodulation in pain |
| title_fullStr | Neuromodulation in pain |
| title_full_unstemmed | Neuromodulation in pain |
| title_short | Neuromodulation in pain |
| title_sort | neuromodulation in pain |
| work_keys_str_mv | AT parkertoa neuromodulationinpain |