Method and apparatus for multimodal electrical modulation of pain
Apparatus and methods for managing pain uses separate varying electromagnetic fields, with a variety of temporal and amplitude characteristics, which are applied to a particular neural structure to modulate glial and neuronal interactions as a mechanism for relieving chronic pain. In another embodiment, a single composite modulation/stimulation signal which has rhythmically varying characteristics is used to achieve the same results as separate varying electromagnetic fields. Also, disclosed is an apparatus and method for modulating the expression of genes involved in diverse pathways including inflammatory/immune system mediators, ion channels and neurotransmitters, in both the Spinal Cord (SC) and Dorsal Root Ganglion (DRG) where such expression modulation is caused by spinal cord stimulation or peripheral nerve stimulation using the disclosed apparatus and techniques. In one embodiment of multimodal modulation therapy, the prime signal may be monophasic, or biphasic, in which the polarity of the first phase of the biphasic prime signal may be either cathodic or anodic while the tonic signal may be either monophasic, or biphasic, with the polarity of the first phase of the biphasic tonic signal being either cathodic or anodic.
1. A method for managing pain in a subject comprising:
A) lowering a threshold for depolarization of nerve fibers in the subject with a first oscillating electromagnetic field for a first duration of time; and
B) simultaneously modulating glial cell activity in the subject with a second oscillating electromagnetic field during a second duration of time not identical to the first duration of time,
wherein the first oscillating electromagnetic field is provided by an electrical signal having a current amplitude set to a value corresponding to a percentage of a Priming Perception Threshold (PPT) of the subject, and
wherein the second oscillating electromagnetic field is provided by an electrical signal having a current amplitude set to a value corresponding to a percentage of the paresthesia threshold (PT) of the subject.
2. The method of claim 1 wherein manipulation of one of the first and second oscillating electromagnetic fields changes synaptic plasticity of neurons and glial cells within the nerve fibers.
3. The method of claim 1 wherein manipulation of one of the first and second oscillating electromagnetic fields causes regulation of Toll-like receptor 2 (tlr2) within the modulated glial cells.
4. The method of claim 1 wherein the first and second oscillating electromagnetic fields are provided by first and second electrical signals, respectively, having different respective frequencies below 1,500 Hz.
5. The method of claim 4 wherein one of the first and second electrical signals has a frequency below the other of the first and second electrical signals.
6. The method of claim 4 wherein the first and second electrical signals have any of different respective amplitudes, frequencies, waveform shapes, widths, and phases relative to each other.
7. The method of claim 4 wherein the first and second electrical signals have different respective phase polarities.
8. The method of claim 4 wherein the first and second electrical signals comprise one of monophasic electrical signals and biphasic electrical signals.
9. The method of claim 4 wherein the first oscillating electromagnetic field and the second oscillating electromagnetic field are provided by a composite electrical signal.
10. The method of claim 9 wherein the composite electrical signal comprises any of a frequency modulated signal, an amplitude modulated signal or a pulse modulated signal.
11. The method of claim 1 wherein manipulation of one of the first and second oscillating electromagnetic fields causes regulation of Chemokine cxcl16 within the modulated glial cells.
12. The method of claim 1 wherein manipulation of one of the first and second oscillating electromagnetic fields causes regulation of calcium binding protein (cabp1) within the modulated glial cells.
13. The method of claim 1 wherein manipulation of one of the first and second oscillating electromagnetic fields causes regulation of Glial maturation factor (Gmfg) within the modulated glial cells.
14. The method of claim 1 wherein the first and second oscillating electromagnetic fields are provided by first and second electrical signals.
15. The method of claim 14 wherein the first and second electrical signals have different respective amplitudes.
16. The method of claim 14 wherein the first and second electrical signals have different respective frequencies.
17. The method of claim 14 wherein the first and second electrical signals have different respective waveform shapes.
18. The method of claim 14 wherein the first and second electrical signals have different respective pulse widths.
19. The method of claim 14 wherein the first and second electrical signals have different respective phases relative to each other.