Vestibular stimulation can relieve central pain of spinal origin

Abstract

Study design: Single-blind, placebo-controlled case report. Setting: Center for Brain and Cognition, University of California, San Diego, CA, USA. Objective and results: We present the case of a 64-year-old woman with right-sided central pain following transverse myelitis of her cervical spinal cord in 2002. We investigated whether her pain could be improved beyond a placebo response by cold caloric vestibular stimulation. She had very little response to two placebo procedures but felt her pain to be markedly lowered in her neck and upper limb by vestibular stimulation. This reduction lasted around 10 days, during which she reported that her pain in these areas was the lowest they had been for years. Conclusions: Her pattern of pain relief is very similar to that reported by patients with central pain arising after thalamic stroke who have reported relief from vestibular stimulation. On the basis of thermosensory disinhibition hypothesis of central pain, we suggest that vestibular stimulation has this beneficial effect because of the intimate anatomical connections between the parieto-insular vestibular cortex and the thermosensory cortex in the dorsal posterior insula. © 2008 International Spinal Cord Society All rights reserved.