Kati Thieme
Background: Recent studies by our group have shown that a specific cardiac cycle triggered electrical stimulation in conjunction with operant-behavioral pain treatment (OBT) can reset the abnormal relationship between blood pressure (BP) and pain in fibromyalgia and chronic pain patients. The process called “systolic extinction training” (SET) promotes a learning process that increases baroreflex sensitivity (BRS), which reestablishes the normal inverse correlation between BP and pain (BP ↑ pain ↓) by activating nucleus tractus solitarius (NTS) reflex arcs. Herein, we present the SET electrical stimulation design, which is administered during the systolic or diastolic phases of the cardiac cycle. Method: The complex trigger for the SET stimulation processes the ECG signal and predicts when the maximum and minimum BP pulse wave at the arterial baroreceptor using a 3-lead derivation by Einthoven. The stimulation routine is: 1) Capture and filter the ECG signal. 2) Calculate the Inter-beat Interval (IBI) for the last 4 beats and predict the next systolic and diastolic trigger points. 3) Deliver a randomized amplitude electrical pulse sequence to avoid adaptation.
Results: By delivering electrical stimuli to the arterial baroreceptor when the pressure wave from the systolic peak is the highest, maximizes the efferent signal to the brain. This type and timing of stimulation is theoretically maximizes the impact in the brain for a given stimulus level and increases the brain’s receptivity to the operant therapy, which then follows.
Conclusion: The described electrical stimulation design is used to activate NTS reflex arcs. Preliminary results suggest that SET provides long lasting treatment effects in diseases such as chronic pain, essential hypertonia, sleep apnea and hyperglycemia.