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Behavioural evidence for vestibular stimulation as a treatment for central post-stroke pain
  1. Paul D. McGeoch (pmcgeoch{at}mac.com)
  1. UCSD, United States
    1. Lisa E. Williams (lewilliams{at}psy.ucsd.edu)
    1. UCSD, United States
      1. Roland R. Lee (rrlee{at}ucsd.edu)
      1. UCSD, United States
        1. Vilayanur S Ramachandran (vramacha{at}ucsd.edu)
        1. University of California, San Diego, United States

          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 trial of caloric vestibular stimulation (CVS) in 9 CPSP patients. Participants rated their pain levels pre and post-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 to 0.54 (SEM= 0.49) for the placebos.

          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 either 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 that they share a common integrative mechanism in the brainstem, which may act to, in effect, reset the balance in central pain.

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