Could normal sensation return after years of complete loss?

Warning: medical specialty jargon ahead

Complications

About 30 million Americans have diabetes.(1) In 2014,108,000 people had lower-extremity amputation.(2) The direct medical cost was $237B.(3) 60 -70% of people with diabetes will experience poly neuropathy, including the loss of sensation.(4) Independent of the cause of pain, not being able to feel your feet leads to a cascade of falls, injuries, wounds, external link to amputations, and early death.(5) Of course, there are many possible causes of neuropathy. (4)

Current interventions may help relieve pain, but the return of normal sensory functions may not be expected.(6)


PhotoMed Technologies was founded after photobiomodulation, then called infrared therapy, had been shown to prompt the return of sensation and relief of pain. However, without real-time recordings, such unexpected events were easily dismissed.

PhotoMed’s software engineers considered the problem a matter of efficiency. Without a medical bias, they accepted the before/after evidence as sufficient to get started. They developed the Instant Verification System™ to record the unexpected events in real time. Later, machine learning (ML) techniques uncovered patterns in the settings that practitioners used to prompt the return back-to-normal (B2N) responses and outcomes.

The ML found patterns provided practitioners with incrementally improved starting settings. Today, the process is called the Triple 2 Algorithm for “Nothing worked” pain and loss of sensation.

There may be myriad reasons for pain’s presence and intensity. After multiple attempts, the gets labeled “nothing worked” pain. The failures rule out various likely causes. Loss of sensation may be “ouchless” or with great pain. The return of sensation, in about 1 in 3 cases, might help prevent later injuries, wounds, and amputations.

There may be myriad reasons for pain’s presence and intensity. After multiple attempts, the gets labeled “nothing worked” pain. The failures rule out various likely causes. Loss of sensation may be “ouchless” or with great pain. The return of sensation, in about 1 in 3 cases, might help prevent later injuries, wounds, and amputations.

 

Loss of sensation

Clips from PhotoMed’s real-time recordings demonstrate the what and the when events occurred. Perhaps now, neuroscientists might learn the why and how of the yet unknown mechanisms.

We use the term “pain” to include the experience of “ouchless” sensations. Impaired functions, such as the loss of protective sensation, may be objectively measured. The patients experience shows their low expectation of the return back-to-normal function.

“George” could NOT feel being touched in either foot after 40-years of diabetes. His feet had remained numb for 8+years. At the end of his second visit, his wife bends his toes to confirm the return of sensation. (Clip = 43 seconds)

 

Link to video showing the correction of his perceived touch locations a few minutes before the above video.

+ More About George

“George” experienced diabetes and its complications for 42 years. He experienced a profound loss of sensation in his feet for 8 - 10 years. He arrived looking at his feet to maintain his balance. George volunteered to learn if PhotoMed’s therapy might relieve his back pain. George and his wife had not considered the possibility of his regaining sensation in his feet.

During his first visit, George’s back pain was partially relieved. Therapy was also applied to his left foot (only). He regained slight awareness of heavy pressure on his left foot.

One week later, George looked at the operator as he walked in. When asked, he reported that he hadn’t noticed much change in his feet. His wife suggested that he now walked more confidently. Von Frey monofilament testing found weak sensations at 19+ grams force. While an improvement, this level is not considered “protective” to prevent falls, etc.

During his second visit, George complied with the request to keep his feet still and to NOT look at his feet. The goal was to avoid cross-sensory perception during the testing. Therapy was applied to both of his feet.

Within 6 minutes of the first treatments, monofilament testing found significant sensation at 5+ grams force. Video clips show the importance of real-time recordings of unexpected events. These may be the first recordings of an event that we hope will become commonplace.


Phantom sensations from surgery, scars, amputations, or reconstructed skin

Phantom pain gets it name from pain in an amputated limb. The sensations may feel real, you know that your hand is missing. Could a scar or reconstructed skin look to be “there”, but be missing from your awareness? For some, it’s like the unusual touch sensations after a Novocain shot at the dentist. Tap on your numb face. What weird sensations do you feel? For others, it’s unrelenting pain. The “nothing worked” type of pain.

PhotoMed’s electronics engineers appreciate the skin’s abundant sensors that provide what and where signals about its interface with the outside world. They admire the local computing of what’s happening before informing the brain. Detection of changes in myriad signals over time and location make the difference between a prick, prod, or pounding pain. They wondered, what’s the brain supposed to do when something goes wrong? Make stuff up? Pain?

The loss of sensation and pain have been shown to co-exist. Like George, you may not be able to feel your feet to maintain walking balance, but they tingle, burn, or feel miserable. Could there be a Halloween-full of different phantoms that come knocking on your door?

Post-surgical pain or numbness
Surgery disturbs connections in severed skin. The what and where information in signals from A and B get scrambled. What’s the brain supposed to think? How long does it take to build a new map?

Machine learning techniques suggested new ways to explain the weird ability for the body to quickly return back-to-normal. Could PhotoMed’s therapy provide a signal to “remap” the area stimulated by a few photons having different quantum properties? What might the engineers record in real time?

Brenda lost sensation in her right fingers after elbow surgery for pain. She volunteered in a study to learn if PhotoMed’s therapy might relieve the pain in her elbow that remained after surgery. She reported incomplete relief from that pain. No one expected her finger sensations to return any time soon.

She was surprised by the return of nearly normal sensations.

Watch as Brenda tests her resumed sensations right after her therapy ended. (Clip = 10 seconds)

 

Restoring sensation does not treat the disease or disorder

Testing PhotoMed’s algorithm for seemingly disparate disorders yielded unexpected responses and outcomes. The abrupt “awakening” of numb fingers or toes sparks surprise for nearly everyone. Could the return of innate sensations break the cascade of falls, injuries, amputations and early death due to diabetes?

Prompting the return to a more normal state does NOT treat the disease, such as diabetes. Could the “awakening” of lost sensation work like taking your cold-numbed hand out of ice water?

Could a few photons, no brighter than in sunlight, provide a signal or catalyst to the body to prompt the “back-to-normal” function that continues after therapy ends?

 

Could brain map errors “explain” phantom pain?

Neuroscientists report pain perceived in amputated limbs, called “phantom” pain. V.S. Ramachandran describes the use of visual feedback in restoring brain functions.(7) Virtual reality for pain studies found neurophysiologic changes related to conditioning and exposure therapies. (8)

“Mirror therapy” and virtual reality typically takes several-to-many visits to achieve lasting benefit. The therapies require the patient to intentionally participate with the hope that neuroplasticity might “rewire” their brain to relieve the “phantom” pain and abnormal sensations.(9)(10)

Could phantom pain account for the pain at scars, post-surgical pain, or phantom pain in reconstructed skin?

Could PhotoMed’s therapy prompt the restore sensation and relieve by prompting the re-mapping of areas having chronic perception errors?

Link to Neuroscience page


Citations

(1) https://www.niddk.nih.gov/health-information/health-statistics/diabetes-statistics NIH Diabetes Statistics 2017

(2) https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf CDC Diabetes Statistics

(3) https://care.diabetesjournals.org/content/41/5/917 Economic Costs of Diabetes in the U.S. in 2017, American Diabetes Association

(4) https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Peripheral-Neuropathy-Fact-Sheet Peripheral Neuropathy Fact Sheet, NIH

(5) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6197166/ Beyaz S, Güler ÜÖ, Bağır GŞ. Factors affecting lifespan following below-knee amputation in diabetic patients. Acta Orthop Traumatol Turcica. 2017;51(5):393–397. doi:10.1016/j.aott.2017.07.001

(6) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4847561/ Juster-Switlik K, Smith AG, Updates in diabetic peripheral neuropathy, doi: 10.12688/f1000research.7898.1

(7) V. S. Ramachandran, Eric L. Altschuler, The use of visual feedback, in particular mirror visual feedback, in restoring brain function, Brain, Volume 132, Issue 7, July 2009, Pages 1693–1710, https://doi.org/10.1093/brain/awp135

(8) Anita Gupta, Kevin Scott, Matthew Dukewich, Innovative Technology Using Virtual Reality in the Treatment of Pain: Does It Reduce Pain via Distraction, or Is There More to It?, Pain Medicine, Volume 19, Issue 1, January 2018, Pages 151–159, https://doi.org/10.1093/pm/pnx109

(9) https://www.mayoclinic.org/diseases-conditions/phantom-pain/diagnosis-treatment/drc-20376278

(10) https://www.frontiersin.org/articles/10.3389/fnhum.2016.00284/full Does a Combination of Virtual Reality, Neuromodulation and Neuroimaging Provide a Comprehensive Platform for Neurorehabilitation? – A Narrative Review of the Literature https://doi.org/10.3389/fnhum.2016.00284