Print Email Facebook Twitter Mitigating Neuropathic Pain: From Theory to Practice Title Mitigating Neuropathic Pain: From Theory to Practice: Inhibiting Neuroma Pain In-silico and Measuring Neural Activity In-vivo Author Verzijl, Hubald (TU Delft Mechanical, Maritime and Materials Engineering) Contributor Malessy, M.J.A. (mentor) Serdijn, W.A. (mentor) Gonçalves Melo Pequito, S.D. (mentor) Neerven, S.G.A. van (mentor) Kolovou Kouri, K. (mentor) Harlaar, J. (graduation committee) Negrello, M. (graduation committee) Degree granting institution Delft University of TechnologyUniversiteit Leiden Programme Technical Medicine | Sensing and Stimulation Date 2021-10-26 Abstract Neuropathic pain (NP) affects approximately seven to ten percent of the general population. Seventeen percent of NP patients scored their life as “worse than death”. A myriad of causes may underlie NP, such as stroke or spinal cord injury. Also, damage or disease of the peripheral nervous system (PNS) may result in NP. One of the main issues of NP caused by a peripheral nerve injury (PNI) is the development of a neuroma, which is a tumor-like mass at the proximal end of a severed nerve that can become very painful. Neuromas show unique neurophysiological characteristics. Cell membrane alternations lead to different ion channel distributions, which in turn result in subthreshold oscillations (SO) and ectopic discharges (ED). It is assumed that this behavior could lead to NP generation. Electrical neurostimulation (ENS) is used to treat patients, thereby applying pre-programmed stimulation patterns to the affected nerves. However, the pain-provoking signals which run through the nerves are not detected and analyzed before ENS is provided. Furthermore, it is questionable whether (the currently applied) pre-programmed ENS defuses these signals anyway. In addition, pre-programmed ENS is not effective at all moments of the pain experience caused by fluctuations in signal intensity. As the clinical results are discouraging, and in view of the high costs, the popularity of this technology is currently waning. Optimization of this potentially powerful technique is needed to improve the outcome and make this technology useful to implement in the treatment strategy of patients with intractable otherwise difficult to treat pain syndromes. Theoretically, optimization of stimulation technology is possible by actually neutralizing SO and ED, which should lead to mitigating the generation of NP. We propose an approach to neutralize SO and ED consisting of several steps. Firstly, the nerve activity is real-time monitored. Secondly, a decision mechanism (called a ‘controller’) is developed that constructs electrical neurostimulation (ENS) patterns to neutralize SO and ED. Finally, these patterns are actually applied to the nerve by an electrical stimulator... Subject neuropathic pain treatmentneuromasubthreshold oscillationsectopic dischargeselectrical neurostimulationclosed-loop controlfractional-order dynamical systemsmodel predictive controlneural amplifiermicroneurographyinterference rejectionneural stimulatorarbitrary waveform stimulatorsingle-unit recordingmulti-unit recording To reference this document use: http://resolver.tudelft.nl/uuid:76795c43-fd1b-4d65-875d-e849b9dea084 Embargo date 2022-10-26 Bibliographical note Double Degree on Technical Medicine | Sensing and Stimulation and Mechanical Engineering | Systems and Control Part of collection Student theses Document type master thesis Rights © 2021 Hubald Verzijl Files PDF Verzijl_2021_Thesis_Mitig ... c_Pain.pdf 11.96 MB PDF Verzijl_2021_Presentation ... c_Pain.pdf 7.78 MB Close viewer /islandora/object/uuid:76795c43-fd1b-4d65-875d-e849b9dea084/datastream/OBJ1/view