Caloric Vestibular Stimulation

Caloric Vestibular Stimulation is an experimental treatment for central pain syndromes.

Pathophysiology

Activation of the parieto-insular vestibular cortex (PIVC) is thought to play a role in relieving central pain. There are two hypothesised mechanisms of action for activation of the PIVC.

• Activation of the adjacent thermosensory cortex in the dorsal posterior insula
• 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. 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.

Resources

Vestibulocortical stimulation pain relief fibromyalgia - Kaplan 2024.pdf - 1.55 MB (f)

Vestibular stimulation for post stroke pain - McGeoch 2008.pdf - 227 KB (f)

Vestibular stimulation central pain of spinal origin - McGeoch 2008.pdf - 76 KB (f)

Vestibular stimulation phantom limb pain - Aranda-Moreno 2019.pdf - 838 KB (f)

Caloric stimulation implications - Miller 2007.pdf - 458 KB (f)

Vestibular stimulation thalamic pain syndrome - ramachandran 2007.pdf - 78 KB (f)