Article Text

PDF
Behavioural evidence for vestibular stimulation as a treatment for central post-stroke pain
  1. P D McGeoch1,
  2. L E Williams1,
  3. R R Lee2,3,
  4. V S Ramachandran1
  1. 1
    Center for Brain and Cognition, University of California, San Diego, California, USA
  2. 2
    Department of Radiology, University of California, San Diego, California, USA
  3. 3
    Veterans Affairs San Diego Healthcare System, San Diego, California, USA
  1. Dr P D McGeoch, University of California, San Diego, Centre for Brain and Cognition, Mandler Hall, 9500 Gilman Drive, Mail Code 0109, La Jolla, CA 92093-0109, USA; pmcgeoch{at}mac.com

Abstract

Background: Central post-stroke pain (CPSP) is often resistant to treatment. We have previously proposed that caloric vestibular stimulation might alleviate it.

Methods: We conducted a single blind placebo controlled investigational study of caloric vestibular stimulation (CVS) in nine patients with CPSP. Participants rated their pain levels before and after the procedure on a 10 point scale.

Results: We found a significant immediate treatment effect of the cold water caloric stimulation with an average pain reduction of 2.58 points (SEM 0.52) for the experimental condition compared with 0.54 points (SEM 0.49) for the placebo conditions.

Conclusions: Participants who responded best to CVS had suffered strokes that spared and permitted activation of the dominant parieto-insular vestibular cortex (PIVC), which is known to be located in the non-dominant hemisphere. These findings tie in closely with the thermosensory disinhibition hypothesis for central pain, which leads us to propose that vestibular stimulation may alleviate CPSP from cross activation between the PIVC and the thermosensory cortex in the adjacent dorsal posterior insula. Alternatively, if one views vestibular function and thermoregulation as part of a larger interoceptive system that exists to maintain homeostasis, then it is possible they share a common integrative mechanism in the brainstem, which may act to reset the balance in central pain.

Statistics from Altmetric.com

Footnotes

  • Competing interests: None.

  • Funding: Our work is partly funded by the C Robbins and R Geckler Foundations, neither of which had any direct input into this study.

  • Ethics approval: The institutional review board of University of California, San Diego, granted ethics approval for the study.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.