Implantable system enabling responsive therapy for pain

• US 20070213783A1
• Filed: 03/13/2006
• Published: 09/13/2007
• Est. Priority Date: 03/13/2006
• Status: Active Grant

• Current Assignee: Neuropace Inc.
• Original Assignee: Neuropace Inc.
• Inventors: Pless, Benjamin
• Granted Patent: US 7,894,905 B2
• Time in Patent Office: Days
• US Class Current: 607/42
• CPC Class Codes: A61F 2007/0075 using a Peltier element, e.g. near the spot to be heated or cooled
• CPC Class Codes: A61F 7/007 characterised by electric heating
• CPC Class Codes: A61M 2005/1726 the body parameters being measured at, or proximate to, the infusion site
• CPC Class Codes: A61M 5/1723 using feedback of body parameters, e.g. blood-sugar, pressure measurement of body parameters A61B5/00
• CPC Class Codes: A61N 1/36071 Pain
• CPC Class Codes: A61N 1/36135 using physiological parameters
• CPC Class Codes: A61N 2/006 for magnetic stimulation of nerve tissue
• CPC Class Codes: A61N 5/0622 Optical stimulation for exciting neural tissue

Abstract

An implantable neurostimulator system for treating pain includes scheduled and responsive therapy capabilities including responsive stimulation applied to the brain and peripheral sections of the nervous system. Methods for treating chronic nociceptive, neuropathic, and psychogenic pain employ an inventive system to advantageously reduce multiple symptoms and components of pain and to address underlying causes of pain.

Claims

1. An implantable apparatus for treating pain in a human patient by selectively applying therapy, the apparatus comprising:

a therapy subsystem coupled to at least one therapy output, wherein the stimulation subsystem is operative to selectively initiate delivery of a therapy to the therapy output.

a detection subsystem coupled to at least one sensor, wherein the detection subsystem is operative to receive and process a detected signal generated by the sensor; and

a processor operative to identify a pain signature in the detected signal and to cause the therapy subsystem to initiate application of the therapy in response thereto.

24. An implantable apparatus for treating neuropathic pain in a human patient by selectively applying therapy, the apparatus comprising:

a therapy subsystem coupled to at least one therapy output located at a therapy location selected from a thalamus, a motor cortex, a brain stem structure, a periaqueductal gray area, a periventricular gray area, a precentral gyrus, or a parietal cortex of the human patient, wherein the stimulation subsystem is operative to selectively initiate delivery of a therapy to the therapy output.

a detection subsystem coupled to at least one sensor located at or near a detection location selected from a primary somatosensory cortex, a secondary somatosensory cortex, an anterior cingulated cortex, a prefrontal cortex, an insular cortex, a thalamus, a spinal cord, or a peripheral nerve of the human patient, wherein the detection subsystem is operative to receive and process a detected signal generated by the sensor; and

a processor operative to identify a pain signature in the detected signal and to cause the therapy subsystem to initiate application of the therapy in response thereto.

25. A method for treating pain in a human patient with an implantable apparatus, the method comprising the steps of:

receiving a signal from at least one sensor at a detection location;

analyzing the signal to detect a pain signature in the signal; and

in response to detecting the pain signature, initiating an action at a therapy location, wherein the action is therapeutic.

28. The method of claim 0 wherein the step of identifying a detection location comprises performing a medical imaging operation.

29. The method of claim 28 wherein the medical imaging operation is selected from PET, SPECT, structural MRI, fMRI, or a spectroscopy technique.

30. The method of claim 0 wherein the step of identifying a detection location comprises performing electrographic mapping.

31. The method of claim 0 further comprising the step of implanting the sensor and coupling the sensor to the apparatus, wherein the sensor is operative to generate a signal representative of a condition at the detection location.

37. An implantable apparatus for treating pain in a human patient by selectively applying therapy, the apparatus comprising:

a therapy subsystem coupled to at least one therapy output, wherein the therapy subsystem is operative to selectively initiate delivery of a therapy to the therapy output.

a detection subsystem coupled to at least one sensor, wherein the detection subsystem is operative to receive and process a detected sensor signal generated by the sensor; and

a processor operative to identify a pain signature in the detected signal and to cause the therapy subsystem to initiate application of the therapy in response thereto, wherein the pain signature represents at least one pain component selected from the group of sensory pain, affective pain, and cognitive pain.

2. The implantable apparatus of claim 37, wherein the sensor is located at or near a detection location selected from a primary somatosensory cortex, a secondary somatosensory cortex, an anterior cingulated cortex, a prefrontal cortex, an insular cortex, a thalamus, a spinal cord, or a peripheral nerve of the human patient.

3. The implantable apparatus of claim 2, wherein the pain signature comprises a pattern occurring in the detection location.

4. The implantable apparatus of claim 3, wherein the pain signature comprises an electrical burst in the thalamus.

5. The implantable apparatus of claim 3, wherein the pain signature comprises an electrographic pattern indicative of activation.

6. The implantable apparatus of claim 3, wherein the pain signature comprises an electrographic pattern indicative of inhibition.

7. The implantable apparatus of claim 3, wherein the pain signature comprises an oscillating signal observed in the thalamus.

8. The implantable apparatus of claim 7, wherein the oscillating signal has a frequency between approximately 0.1 Hz and approximately 1.0 Hz.

9. The implantable apparatus of claim 8, wherein the oscillating signal has a frequency between about 0.2 Hz and 0.4 Hz.

10. The implantable apparatus of claim 7, wherein the sensor is implanted in a ventroposterolateral thalamic nucleus.

11. The implantable apparatus of claim 37, wherein the therapy output comprises an electrical stimulation electrode, a catheter coupled to a drug dispenser, or a thermal conductor coupled to a thermal stimulator.

12. The implantable apparatus of claim 37, wherein the therapy output is located at a therapy location selected from a thalamus, a motor cortex, a brain stem structure, a periaqueductal gray area, a periventricular gray area, a precentral gyrus, or a parietal cortex of the human patient.

13. The implantable apparatus of claim 12, wherein the therapy location is patient-specific.

14. The implantable apparatus of claim 37, wherein the implantable apparatus comprises a plurality of detection channels.

15. The implantable apparatus of claim 14, wherein each of the plurality of detection channels is capable of being operated independently.

16. The implantable apparatus of claim 37, wherein the implantable apparatus comprises a plurality of therapy outputs.

17. The implantable apparatus of claim 16, wherein each of the plurality of therapy outputs is capable of being controlled independently.

18. The implantable apparatus of claim 37, wherein the implantable apparatus comprises a master device.

19. The implantable apparatus of claim 18, wherein the implantable apparatus further comprises a remote sensing module.

20. The implantable apparatus of claim 18, wherein the implantable apparatus further comprises a remote therapy module.

21. The implantable apparatus of claim 37, wherein the pain comprises nociceptive pain.

22. The implantable apparatus of claim 37, wherein the pain comprises neuropathic pain.

23. The implantable apparatus of claim 37, wherein the pain comprises psychogenic pain.

38. The device of claim 37, wherein the at least one pain component includes a central aspect, a peripheral aspect, or an idiopathic aspect.

39. The device of claim 37, wherein the pain signature arises from a nociceptive pain, a neuropathic pain, or neurogenic pain experienced by the patient.

40. The device of claim 37, further comprising a therapy management component adapted to control the therapy subsystem according to at least one control law.

41. The device of claim 40, wherein the therapy management component is coupled to receive input from at least one of the processor and the detection subsystem.

42. The implantable apparatus of claim 37, wherein the therapy output comprises an electrical stimulation electrode, a magnetic stimulator, a transcranial magnetic stimulator, an optical stimulator, a catheter coupled to a drug dispenser, or a thermal conductor coupled to a thermal stimulator.

43. The implantable apparatus of claim 42, further comprising at least one additional therapy output to form a plurality of therapy outputs, wherein each of the plurality of therapy outputs is capable of being controlled independently.

44. The implantable apparatus of claim 43, wherein each of the therapy outputs is positioned and programmed to treat a pain component.

45. The implantable apparatus of claim 43, wherein the at least one pain component includes a central aspect, a peripheral aspect, or an idiopathic aspect, and wherein each of the therapy outputs is positioned and programmed to treat an aspect of the pain component.

46. A method for treating pain in a human patient with an implantable apparatus, the method comprising the steps of:

receiving a sensor signal from at least one sensor at a detection location;

analyzing the sensor signal to detect a pain-related event in the signal; and

in response to detecting the pain-related event, initiating an action at a therapy location, wherein the action is therapeutic.

26. The method of claim 46 further comprising the step of implanting the apparatus in the human patient.

27. The method of claim 64 further comprising the step of identifying the detection location.

32. The method of claim 64 further comprising the step of identifying a therapy location.

33. The method of claim 32 further comprising the step of implanting the therapy output at the therapy location and coupling the therapy output to the apparatus, wherein the apparatus is thereby operative to deliver a therapy to the therapy location.

34. The method of claim 46, wherein the action treats a sensory component of the pain.

35. The method of claim 46, wherein the action treats an affective component of the pain.

36. The method of claim 46, wherein the action treats a cognitive component of the pain.

47. The method of claim 46 wherein the action is therapeutic to at least one of a behavioral symptom, an electrophysiological symptom, or a cognitive symptom of the pain.

48. The method of claim 46, wherein the step of detecting the pain-related event comprises observing a pain signature in the sensor signal.

49. The method of claim 48, wherein the pain signature comprises a plurality of types of pain.

50. The method of claim 49, wherein the plurality of types of pain includes at least two of a central component, a peripheral component, and an idiopathic component.

51. The method of claim 48 wherein the pain signature is correlated with a sensory, affective, cognitive, or state component of the pain.

52. The method of claim 48 wherein the step of observing the pain signature comprises performing at least one of the steps of spectral analysis, template matching, spectral analysis, linear or non-linear signal processing, a computational algorithm, fuzzy logic, or chaotic analysis on the signal.

53. The method of claim 48 wherein the step of observing a pain signature produces at least one score.

54. The method of claim 53, wherein the score comprises a probability value.

55. The method of claim 53, wherein the score comprises an index value.

56. The method of claim 48, wherein the step of detecting a pain signature comprises comparing at least a portion of the sensor signal to a threshold data value, a statistical feature, or a template.

57. The method of claim 48, wherein the step of detecting a pain signature further comprises the step of calculating a pain parameter, and wherein the method further comprises the step of using the pain parameter with at least one control law to calculate at least one therapy parameter.

58. The method of claim 48, wherein the step of detecting a pain signature comprises the step of measuring the sensor signal with a spectral resolution between about 0.1 Hz and about 0.3 Hz.

59. The method of claim 48, wherein the step of detecting a pain signature comprises the step of measuring a power in a frequency band of the sensor signal.

60. The method of claim 48, wherein the step of detecting a pain signature comprises the step of integrating a filtered signal, wherein the filtered signal represents the sensor signal within a frequency band.

61. The method of claim 46, wherein the detection location comprises the thalamus and the therapy location comprises the periaqueductal gray region.

62. The method of claim 46, wherein the step of initiating an action is performed according to at least one control law.

63. The method of claim 46, further comprising the step of identifying the detection location by performing a medical imaging operation during a task, subsequent to the administration of a drug, or during behavioral modification.

64. The method of claim 46 further comprising the step of implanting the apparatus in the human patient.