Student Presentation -- Shana Black
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Ph.D. Research Proposal, Tuesday January 22, 2019 -- Image-Based Analysis and Neuromodulation for Neuropathic Pain

WEB 3780 Evans conference room at SCI, 10:00 am

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Speaker: Shana Black. Advisor: Dr. Christopher Butson


Abstract:

Neuropathic pain (NP) is a spontaneous, chronic pain condition estimated to affect 9.8% of the general population. Of the roughly 300,000 spinal cord injured (SCI) patients in the US, 50-60% suffer from this debilitating condition for which pharmacological therapies offer limited efficacy and have side effects that cause both cognitive and motor deficits. Although there has been substantial research into non-pharmacological therapies for NP, the SCI population remains understudied and advancement in clinical treatment options has been relatively stagnant. Patients are often classified phenomenologically, relying on patient reported outcomes, making it difficult to provide unbiased treatment evaluation and patient stratification. Mechanistic understanding and an objective means for diagnosis must be established to properly classify patients and treat pain conditions.

Neuroimaging has been previously used to identify functional activation patterns during acute pain and structural reorganization in response to some chronic pain conditions, and recent evidence suggests that NP sub-populations are differentiable based on neurophysiological signatures. However, many of the neurological conditions that give rise to NP are associated with substantial reorganization within the brain independent of the development of NP, and the vast majority of studies attempting to identify NP specific neurological changes use healthy controls without any history of the primary neurological diagnosis. With proper controls, neuroimaging may allow for identification of neurological biomarkers and reactionary mechanisms in the brain to improve patient-specific NP assessment and treatment. Focusing on single NP sub-populations will allow for better mechanistic understanding of sub-populations and guide novel approaches to NP therapy.

Neuromodulation has emerged as a promising alternative to pharmacological treatment for NP and is a potential approach to validate mechanisms identified via neuroimaging. Transcranial magnetic stimulation (TMS) is a non-invasive neuromodulation therapy with minimal side effects that may be effectual in the treatment of NP. However, study results are variable and often implement the same strategies on heterogeneous populations, warranting additional research with a focus on individual diagnoses. We hypothesize that SCI NP patients will have quantifiable differences in neural activation patterns and structural anatomy compared to SCI patients without NP. Our long-term goal is to utilize these differences to develop objective patient classification measures and guide TMS therapy in SCI NP patients.