Method and apparatus for pain control using baroreflex sensitivity during posture change

• US 10,667,747 B2
• Filed: 10/19/2017
• Issued: 06/02/2020
• Est. Priority Date: 10/25/2016
• Status: Active Grant

• Current Assignee: Boston Scientific Neuromodulation Corporation (Boston Scientific Corporation)
• Original Assignee: Boston Scientific Neuromodulation Corporation (Boston Scientific Corporation)
• Inventors: Annoni, Elizabeth Mary, Thakur, Pramodsingh Hirasingh, Clark, Bryan Allen, Srivastava, Kyle Harish, Gu, Jianwen, Kleinedler, James John, Ternes, David J., Perschbacher, David L.
• Primary Examiner(s): Schaetzle, Kennedy
• Application Number:
  US15/788,403
• Publication Number:
  US 20180110464A1
• Time in Patent Office: 957 Days
• Field of Search: None
• CPC Class Codes: A61B 5/0205 Simultaneously evaluating both cardiovascular conditions and different types of body conditions, e.g. heart and respiratory condition
• CPC Class Codes: A61B 5/021 Measuring pressure in heart or blood vessels A61B5/0205 takes precedence
• CPC Class Codes: A61B 5/024 Detecting, measuring or recording pulse rate or heart rate A61B5/0205, A61B5/021 take precedence
• CPC Class Codes: A61B 5/02405 Determining heart rate variability
• CPC Class Codes: A61B 5/0816 Measuring devices for examining respiratory frequency measuring frequency of electric signals G01R23/00
• CPC Class Codes: A61B 5/1116 Determining posture transitions
• CPC Class Codes: A61B 5/1118 Determining activity level
• CPC Class Codes: A61B 5/4824 Touch or pain perception evaluation A61B5/4821 takes precedence
• CPC Class Codes: A61B 5/7282 Event detection, e.g. detecting unique waveforms indicative of a medical condition A61B5/4094, A61B5/4818, A61B5/349, A61B5/0823 take precedence
• CPC Class Codes: A61N 1/36021 for treatment of pain
• CPC Class Codes: A61N 1/36062 Spinal stimulation
• CPC Class Codes: A61N 1/36071 Pain
• CPC Class Codes: A61N 1/36139 with automatic adjustment

Abstract

An example of a system for providing a patient with pain management includes a pain monitoring circuit. The pain monitoring circuit may include parameter analyzer circuitry and pain score generator circuitry. The parameter analyzer circuitry may be configured to receive and analyze one or more timing parameters and one or more baroreflex parameters allowing for determination of baroreflex sensitivity (BRS) of the patient. The one or more timing parameters are indicative of time intervals during which values of the one or more baroreflex parameters are used to determine the BRS. The pain score generator circuitry may be configured to compute a pain score using an outcome of the analysis. The pain score is a function of the BRS during the time intervals and indicative of a degree of pain of the patient.

Claims

1. A system for providing a patient with pain management, the system comprising:

a pain monitoring circuit including;

parameter analyzer circuitry configured to receive and analyze one or more timing parameters and one or more baroreflex parameters allowing for determination of baroreflex sensitivity (BRS) of the patient, the one or more timing parameters indicative of time intervals during which values of the one or more baroreflex parameters are used to determine the BRS and including at least one of a posture parameter or an activity parameter, the posture parameter indicative of a posture of the patient, the activity parameter indicative of a level of physical activity of the patient; and

pain score generator circuitry configured to compute a pain score using an outcome of the analysis, the pain score being a function of the BRS during the time intervals and indicative of a degree of pain of the patient;

a pain relief device configured to deliver one or more pain-relief therapies to the patient; and

a control circuit configured to control the delivery of the one or more pain-relief therapies using the computed pain score.

2. The system of claim 1, wherein the parameter analyzer circuitry is further configured to generate a BRS signal metric using the one or more timing parameters and the one or more baroreflex parameters, and the pain score generator circuitry is further configured to compute the pain score using the BRS signal metric.

3. The system of claim 1, wherein the pain monitoring circuit further comprises:

one or more baroreflex sensors configured to sense one or more baroreflex signals allowing for the determination of the BRS; and

a parameter generator configured to generate the one or more baroreflex parameters using the one or more timing parameters and the one or more baroreflex signals.

4. The system of claim 3, wherein the parameter analyzer circuitry is further configured to receive and analyze the posture parameter and the one or more baroreflex parameter and is further configured to determine the BRS of the patient as a function of the posture of the patient.

5. The system of claim 4, wherein the posture parameter is indicative of one or more of a type, a magnitude, a duration, a velocity, or an acceleration of a change in the posture of the patient, and the parameter analyzer circuitry is further configured to generate the BRS signal metric representative of the BRS of the patient being a function of the one or more of the type, the magnitude, the duration, the velocity, or the acceleration of the change in the posture of the patient.

6. The system of claim 3, wherein the parameter analyzer circuitry is further configured to receive and analyze the activity parameter and the one or more baroreflex parameter and is further configured to determine the BRS of the patient as a function of the level of physical activity of the patient.

7. The system of claim 3, wherein the parameter analyzer circuitry is further configured to receive and analyze one or more respiratory parameters of the one or more timing parameters and the one or more baroreflex parameter, the one or more respiratory parameters indicative of respiratory cycles of the patient, the respiratory cycles each including an inspiration phase and an expiration phase, and is further configured to determine the BRS of the patient using values of the one or more baroreflex parameters during one or more of inspiration phases or expiration phases of the respiratory cycles of the patient.

8. The system of claim 3, wherein the one or more baroreflex sensors are further configured to sense at least a cardiac signal of the one or more baroreflex signals, the cardiac signal indicative of cardiac electrical activities of the patient, and the baroreflex parameter generator is further configured to generate one or more of a heart rate, a change in the heart rate, a slope of the change in the heart rate, or a heart rate variability.

9. The system of claim 3, wherein the one or more baroreflex sensors are further configured to sense at least a blood pressure signal of the one or more baroreflex signals, the blood pressure signal indicative of a blood pressure or physiological activities driven by the blood pressure or a change in the blood pressure of the patient, and the baroreflex parameter generator is further configured to generate one or more of a blood pressure parameter, a change in the blood pressure parameter, a slope of the change in the blood pressure parameter, or a measure of a neural activity driven by the blood pressure or the change in the blood pressure, the blood pressure parameter being an actual blood pressure or a surrogate of the blood pressure of the patient.

10. A method for managing pain of a patient, comprising:

receiving and analyzing one or more timing parameters and one or more baroreflex parameters allowing for determination of baroreflex sensitivity (BRS) of the patient, the one or more timing parameters indicative of time intervals during which values of the one or more baroreflex parameters are used to determine the BRS and including at least one of a posture parameter or an activity parameter, the posture parameter indicative of a posture of the patient, the activity parameter indicative of a level of physical activity of the patient;

computing a pain score using an outcome of the analysis, the pain score being a function of the BRS during the time intervals and indicative of a degree of pain of the patient;

delivering one or more pain-relief therapies to the patient from a pain relief device; and

controlling the delivery of the one or more pain-relief therapies using the pain score.

11. The method of claim 10, wherein analyzing the one or more timing parameters and the one or more baroreflex parameters comprises generating a BRS signal metric using the one or more timing parameters and the one or more baroreflex parameters, and computing the pain score comprises computing the pain score using the BRS signal metric.

12. The method of claim 10, further comprising:

sensing a posture signal indicative of the posture of the patient using a posture sensor; and

generating the posture parameter using the posture signal.

13. The method of claim 10, further comprising:

sensing an activity signal indicative of the level of physical activity of the patient using an activity sensor; and

generating the activity parameter using the activity signal.

14. The method of claim 10, further comprising:

sensing one or more respiratory signals indicative of respiratory cycles of the patient using one or more respiratory sensors; and

generating one or more respiratory parameters of the one or more timing parameters using the one or more respiratory signals.

15. The method of claim 10, further comprising:

sensing one or more baroreflex signals allowing for the determination of the BRS using one or more baroreflex sensors; and

generating the one or more baroreflex parameters using the one or more baroreflex signals.

16. The method of claim 15, wherein sensing the one or more baroreflex signals comprises sensing one or more of a cardiac signal indicative of a heart rate of the patient or a blood pressure signal indicative of a blood pressure of the patient.

17. The method of claim 16, wherein generating the one or more baroreflex parameters comprises generating a parameter indicative of one or more of a heart rate, a change in the heart rate, a slope of change in the heart rate, or a heart rate variability.

18. The method of claim 16, wherein generating the one or more baroreflex parameters comprises generating a blood pressure parameter, a change in the blood pressure parameter, a slope of the change in the blood pressure parameter, or a measure of a neural activity driven by the blood pressure or the change in the blood pressure, the blood pressure parameter indicative of the blood pressure of the patient.

19. A non-transitory computer-readable storage medium including instructions, which when executed by a system, cause the system to perform a method for managing pain of a patient, the method comprising:

receiving and analyzing one or more timing parameters and one or more baroreflex parameters allowing for determination of baroreflex sensitivity (BRS) of the patient, the one or more timing parameters indicative of time intervals during which values of the one or more baroreflex parameters are used to determine the BRS and including at least one of a posture parameter indicative of a posture of the patient or an activity parameter indicative of a level of physical activity of the patient;

computing a pain score using an outcome of the analysis, the pain score being a function of the BRS during the time intervals and indicative of a degree of pain of the patient;

delivering one or more pain-relief therapies to the patient from a pain relief device; and

controlling the delivery of the one or more pain-relief therapies using the pain score.

20. The non-transitory computer-readable storage medium of claim 19, wherein the one or more baroreflex parameters comprise at least one of a blood pressure parameter, a change in the blood pressure parameter, a slope of the change in the blood pressure parameter, or a measure of a neural activity driven by the blood pressure or the change in the blood pressure, the blood pressure parameter indicative of a blood pressure of the patient.