Authors: Baldeep S. Dhaliwal, John Haddad, Mark Debrincat, Peter Hurwitz.
Background: Globally, pain and pain-related diseases are the leading causes of disability and disease burden. In the United States, pain is the most common reason patients consult primary care providers. An estimated 100 million people live with chronic or recurrent pain. Existing pharmacological treatments for pain include anti-inflammatory agents, opioids, and other oral and topical analgesics. Many of these have been associated with troublesome and potentially harmful adverse effects. Understanding the complex pain neuromatrix may help in identifying alternative, non-invasive strategies and treatment approaches to address pain severity, interference, and improve patient outcomes.
The neuromatrix of pain is a network of neuronal pathways and circuits responding to sensory (nociceptive) stimulation. Research has suggested that the output patterns of the body-self neuromatrix are responsible for causing or triggering perceptual, homeostatic, and behavioral programs following traumatic injury, other pathology, or chronic stress. As such, pain can be considered a product of the output of a widely distributed neural network within the brain instead of a sequential result of sensory inputs triggered by injury, inflammation, or other pathology. For over a century, the Brodmann Areas remain the most widely known and frequently cited cytoarchitectural organization of the human cortex. Certain Brodmann areas of the brain have been associated with the current understanding of the neuromatrix of pain. The areas expands well beyond the thalamus and anterior cingulate, and primary (S1) and secondary (S2) somatosensory cortices to include the midbrain region of the periaqueductal gray (PAG) and the lenticular complex as well as the insula, orbitofrontal (Brodmann's area [BA] 11, 47), prefrontal (BA 9, 10, 44-46), motor (BA 6, Supplementary motor area, and M1), inferior parietal (BA 39, 40), and anterior cingulate (BA 24, 25) cortices (ACCs). Treatments that are non-invasive and non-pharmacological and target both central and peripheral nociceptive mechanisms that are identified as having an impact on the Brodmann areas associated with the neuromatrix of pain may potentially be considered a beneficial pain management option for patients.
Haptic vibrotactile trigger technology targets the nociceptive pathways and is theorized to disrupt the neuromatrix of pain. The technology has been incorporated into non-pharmacological patches and other non-invasive routes of delivery such as apparel (socks), braces, wristbands, and compression sleeves.
The purpose of this minimal risk study was to compare electroencephalogram (EEG) patterns in areas of the brain that have been associated with the neuromatrix for pain in subjects wearing socks that were embedded with haptic vibrotactile trigger technology with those patients that wore socks that were not embedded with the technology.
Methods: This IRB-approved study compared electroencephalogram (EEG) patterns in subjects wearing cloth socks embedded with haptic vibrotactile trigger technology (Superneuro VTT Enhanced Socks (Srysty Holding Co., Toronto, Canada) with those patients that wore cloth socks that were not embedded with the technology. Baseline EEG data from 19 scalp locations were recorded in sixty (60) adult subjects (36 females and 24 males) ranging from ages 14 to 83 wearing standard store-purchased cloth socks on their feet. The subject’s standard socks were then removed and replaced with the Superneuro VTT enhanced socks on the subject’s feet. A second EEG recording was then obtained. Both eyes-closed and eyes-open data were recorded.
Results: The results showed statistically significant t-test differences (P < .01) in 59 out of 60 subjects in absolute power and 60 out of 60 subjects showed statistically significant differences in coherence and phase difference. The largest differences were in the alpha1 and beta2 frequency bands and especially in central scalp locations. Paired t-tests of LORETA current source densities between socks on and socks off demonstrated statistically significant differences in 60 out of 60 subjects. The largest effects of Superneuro VTT enhanced socks on were on the medial bank of the somatosensory cortex as well as in the left frontal lobes in the theta and alpha frequency.
Conclusions: Study results indicate that foot stimulation with embedded haptic vibrotactile trigger technology showed significant modulation in the Brodmann areas that have been shown to be associated with the neuromatrix for pain in the human brain. Further research is suggested to evaluate if this technology has a positive impact on pain severity, pain interference, and quality of life and to be considered as a potentially beneficial pain management strategy and as part of a multi-modal treatment approach.