We have developed a non-invasive, evocative test (‘TAP’ for transcutaneous acoustic palpation) that uses intense focused ultrasound (iFU) under image guidance (in a device therefore called an igiFU device) to stimulate focal volumes of tissue deep to the skin in a way blinded to both the user and the patient. As such, this approach holds the promise of helping the clinician, in the context of a clinical exam, to localize potential sources of pain deep to the skin. Here we propose to use TAP, embodied within a pre-clinical ig-iFU system, and applied to amputee patients, to make practical advances on the following concrete issues germane to pain experienced by our warriors with amputations, with the likely generalization of this technique to other painful etiologies. (1) Localizing pain (peripheral pain generators; (2) Identification of the action of central sensitization; (3) Determining the ability of Targeted Muscle Reinnervation (TMR) surgery to reduce pain.
Sponsor: Department of Defense