Validation, reproducibility and safety of trans dermal electrical stimulation in chronic pain patients and healthy volunteers

Abstract

Background: Surrogate pain models have been extensively tested in Normal Human Volunteers (NHV). There are few studies that examined pain models in chronic pain patients. Patients are likely to have altered pain mechanisms. It is of interest to test patient pain responses to selective pain stimuli under controlled laboratory conditions.

Methods: The Institutional Ethic Committee approved the study. 16 patients with chronic neuropathic radiculopathy and 16 healthy volunteers were enrolled to the study after obtaining informed consent. During electrical stimulation (150 minutes for volunteers and 75 minutes for patients) the following parameters were measured every 10 minutes: Ongoing pain: Visual Analogue Scale (VAS) and Numeric Rate Scale (NRS)Allodynia (soft foam brush)Hyperalgesia (von Frey monofilament 20 g)Flare. For each endpoint, the area under the curve (AUC) was estimated from the start of stimulation to the end of stimulation by the trapezoidal rule. The individual AUC values for both periods were plotted to show the inter- and intra-subject variability. For each endpoint a mixed effect model was fitted with random effect subject and fixed effect visit. The estimate of intra-subject variance and the mean value were then used to estimate the sample size of a crossover study required to have a probability of 0.80 to detect a 25% change in the mean value. Analysis was done using GenStat 8th edition.

Results: Each endpoint achieved very good reproducibility for patients and NHV. Comparison between groups revealed trends towards: Faster habituation to painful stimuli in patients. Bigger areas of hyperalgesia in patients. Similar area of allodynia and flare (no statistical significance)

Conclusion: The differences demonstrated between patients and NHVs suggest that the electrical stimulation device used here may stimulate pathways that are affected in the pathological state.

Figure 1

Transdermal Electric Pain Stimulator (HV-1). A) Stimulator without enclosure. Electrostatic-like discharges are visible between skin and the electrodes, B) Scheme of the stimulation head, C) Stimulator is simply attached to the forearm by Velcro strap.

Figure 2

Individual time courses of electrical current intensity during the ramping-up period (0-15 min) by visit. Thick lines, Visit1; dotted line, Visit2; a. Healthy volunteers; b. Patients.

Figure 3

Average time course (0-75 min) of NRS (left panel) and VAS (right panel) pain scores at each visit. The electrical stimulation was maintained for 155 minutes in HVs; and for 85 minutes in patients. Thick line, healthy volunteers; dotted lines, patients. Circles, Visit1; Crosses, Visit2.

Figure 4

Average time course (0-75 min) of visual flare diameter at each visit. Thick line, healthy volunteers; dotted lines, patients. Circles, Visit1; Crosses, Visit2.

Figure 5

Average time course (0-75 min) of allodynia diameter at each visit. Thick line, healthy volunteers; dotted lines, patients. Circles, Visit1; Crosses, Visit2.

Figure 6

Average time course (0-75 min) of hyperalgesia diameter at each visit. Thick line, healthy volunteers; dotted lines, patients. Circles, Visit1; Crosses, Visit2.