Caloric Vestibular Stimulation: Difference between revisions
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Caloric Vestibular Stimulation is an experimental treatment for central pain syndromes such as post stroke syndrome, [[Fibromyalgia]], and phantom limb pain. | Caloric Vestibular Stimulation is an experimental treatment for central pain syndromes such as post stroke pain syndrome, [[Fibromyalgia]], and phantom limb pain. | ||
==Pathophysiology== | ==Pathophysiology== | ||
Revision as of 20:44, 31 July 2024
Caloric Vestibular Stimulation is an experimental treatment for central pain syndromes such as post stroke pain syndrome, Fibromyalgia, and phantom limb pain.
Pathophysiology
One hypothesis for central pain is the "thermosensory disinhibition hypothesis." In this hypothesis central pain occurs due to the loss of central inhibition by cooling. With temperatures below 25°C there is activation of both cold thermoreceptors (A-delta fibres) and C-nociceptors. These two types of fibres pass through to the thalamus via the spinothalamic tract. From the thalamus, the C-fibres reach to the anterior cingulate cortex (ACC), and the A-delta fibres reach to the dorsal posterior insula (dpIns). In a normal state, the A-delta fibres activate the dpIns to reduce pain at the ACC. When the temperature falls below 15°C then there is relatively greater C fibre activity, hence the ACC is not suppressed by the dpIns and the sensation is perceived as painful. With damage to the spinothalamocortical pathway that terminate in the dpIns there can be disinhibition of the ACC causing pain.[1]
The mechanism by which caloric vestibular activation relieves central pain is through to be through activation of the parieto-insular vestibular cortex (PIVC), a structure adjacent to the dpIns. There are two hypothesised mechanisms of action for activation of the PIVC.[1]
- Activation of the adjacent thermosensory cortex in the dorsal posterior insula (dpIns)
- Rebalancing integration of thermosensory information by suppressing thermal pain at the anterior cingulate cortex (ACC)
There is generally greater and more sustained pain relief in the head and upper limbs than the lower limbs. Repeated irrigation may show greater relief in lower limb pain. The best results are seen in those where it is possible to activate the dominant PIVC, located in the non-dominant hemisphere. The vestibular outflow from the thalamus to the PIVC is located in the posterolateral thalamus.
Instructions
Irrigate the ear with 4°C water for 30 seconds at a rate of 1-2mL per second. If successful it may be repeated. Patients can be taught to do it at home every 1-2 weeks.
Resources
References
Literature Review
Literature Review
- Reviews from the last 7 years: review articles, free review articles, systematic reviews, meta-analyses, NCBI Bookshelf
- Articles from all years: PubMed search, Google Scholar search.
- TRIP Database: clinical publications about evidence-based medicine.
- Other Wikis: Radiopaedia, Wikipedia Search, Wikipedia I Feel Lucky, Orthobullets,
