Augmented System Research Articles

1071 Initial Experience Using an Augmented Reality Head-Mounted Display System During Surgical Management of Thoracolumbar Spinal Trauma

INTRODUCTION: Advancements in trauma medicine can improve the speed and accuracy of care response with a major impact on downstream operative outcomes. Augmented reality using a head-mounted-display (AR-HMD) is a novel technology that may be applied to spine surgery to provide surgeons with a real-time CT-guided 3-dimensional reconstruction of a patient’s spinal anatomy. METHODS: We retrospectively reviewed trauma patients who underwent pedicle screw placement guided by AR-HMD or robotic-assisted platforms at an academic tertiary care center between January 1, 2021 and December 31, 2022. Demographic, clinical, cost, and perioperative outcome information was analyzed and outcome profiles were compared using a U test. RESULTS: The AR cohort (4 females, 5 males) had a mean age of 66.0 years, BMI of 29.4 kg/m2, Charlson Comorbidity Index (CCI) of 4.11, and Surgical Invasiveness Index (SII) of 8.78. Pedicle screws (77) were placed in the thoracic (51%), lumbar (39%), and sacral spine (10%). Intraoperatively, there was a mean blood loss of 377.78 ml, 0.78 units transfused, 398.33 minutes spent in the operating room, and a 20.00 day LOS. The average 3-month, 6-month, and 12-month ODI scores were 14.25 (n = 8), 15.40 (n = 5), and 12.66 (n = 3). The robotic cohort (5 females, 8 males) had a mean age of 55.6 years, BMI of 27.1 kg/m2, CCI of 3.77, and SII of 14.23. Pedicle screws (128) were placed in the thoracic (59%), lumbar (37%), sacral spine (2%), iliac spine (2%), and pelvis (2%). Intra-operatively, there was a mean blood loss of 431.54 ml, 0.46 units transfused, 330.61 minutes spent in the operating room, and a 10.38 day LOS. The average 3-month, 6-month, and 12-month ODI scores were 22.67 (n = 9), 18.60 (n = 5), and 29.50 (n = 2). CONCLUSIONS: This case series demonstrates the utility of AR-HMD in surgical spinal trauma cases by showing operative outcomes comparable to those observed in robotic-assisted surgery.

The Accuracy of Cup Placement in Total Hip Arthroplasty (THA) Using an Augmented Reality-Based Navigation System.

Background AR HIP Navigation System® (AR-navi; Zimmer-Biomet, Warsaw, IN) is a portable navigation system employing augmented reality via a smartphone app, which was developed in Japan. We retrospectively analyzed the accuracy of cup placement in total hip arthroplasty (THA) using AR-navi,to investigate whether obesity is associated with an absolute value error in cup placement angle. Methods We retrospectively analyzed 45 hips in 43 patients who underwent THA using AR-navi (AR-navi group) and compared them with 45 hips in 45 patients who underwent THA using alignment rods (conventional group). Results The mean absolute error of cup placement (AR-navi group vs. conventional group) was found to be 2.60° (±2.11) in radiographic inclination (RI) for the AR-navi group and 4.61° (±3.28) for the conventional group, which indicates significant difference in the AR-navi group compared to that in the conventional group (p = 0.0036). The mean absolute error of radiographic anteversion (RA) was 3.57° (±3.36) for the AR-navi group and 3.87° (±2.97) for the conventional group (p = 0.4732). The mean absolute error of RI was 2.36° (±2.24) in the obese group and 3.16° (±2.03) in the nonobese group, and the mean absolute error of RA was 4.08° (±4.51) and 3.16° (±2.05) in the obese and nonobese groups, respectively. Conclusions Cup placement accuracy for THA using AR-navi was 2.60 ± 2.11° for RI and 3.87 ± 2.97° for RA. Compared to THA using the conventional method, the RI installation error was significantly improved with AR Navi. There was no significant difference in the mean absolute error of RI and RA among the obese and nonobese groups.

Laparoscopic hepatectomy for hepatocellular adenoma using the hepatic vein as anatomic markers,How I do it.(with video)

TechniqueHepatocellular adenoma (HCA) is a benign monoclonal tumour that originates from mature hepatocytes.Liver resection is recommended in case of overt malignant transformation to hepatocellular carcinoma.However, hepatobiliary surgeries are technically challenging in patients with giant HCA (GHCA) owing to the risk of catastrophic intraoperative bleeding and difficulty with its control during laparoscopic treatment. We present a technical note on the utilization of the hepatic vein as anatomical landmarks for laparoscopic removal of giant hepatic glands, without intraoperative ultrasonography and with the aid of an augmented reality navigation system during surgery. ResultsThis video shows aA 37-year-old man was recommended treatment for a progressively increasing HCA (from 3 to 10 cm in a year) involving the right hepatic vein (RHV), inferior vena cava (IVC) and middle hepatic vein (MHV), resulting in the invisibility of the above intrahepatic anatomic markers in CT. Laparoscopic hepatectomy was performed using the hepatic vein as anatomic markers in a treatment centre specialising in minimally invasive surgeries. The procedure involved fully mobilising the right liver, transecting the parenchyma along the demarcation line in the caudal-to-cranial direction, exposing the involved caudal MHV, isolating and transecting the involved RHV and preserving the integrity of the involved IVC. ConclusionsLaparoscopic hepatectomy for intractable GHCA using the involved intrahepatic anatomic markers is feasible and effective. It reduces pre-operative haemorrhage and open conversion rates while maximising postoperative hepatic function.

The Perceptions of Speech-language Pathologists toward Augmentative and Alternative Communication in China

The purpose of this study is to investigate the awareness and use of Augmentative and Alternative Communication (AAC) systems, as well as the related training received by speech therapists in China. A questionnaire survey was designed and distribute to speech therapists in hospitals, rehabilitation organizations and universities in China. A total of 50 valid questionnaires were returned. The results showed that 94% of the speech therapists had heard of various AAC tools. However, only 10% of the speech therapists considered themselves proficient in providing AAC assessment and intervention services. 30% of them had never received AAC training, 48% had attended seminars or lectures related to AAC but had not received systematic training, and 20% had only received less than 1 day of training. 80% of the speech therapists expressed a strong interest in participating in AAC training, and most of the speech therapists believed that the AAC tools helped improve their patients’ communication skills. This research provided insights into how Chinese speech therapists perceived AAC devices. However, the research also revealed a lack of training and experience with AAC in China.

Code-Carrier coherence monitoring for dual frequency SBAS

User differential range error (UDRE) is used to bound satellite clock and orbit errors in satellite-based augmentation system (SBAS). The code carrier incoherence (CCI) originated from satellite payload faults may degrade generated satellite corrections and corresponding UDRE/DFRE bounding. To ease the burden on UDRE caused by the CCI induced ranging error, a code carrier coherence (CCC) monitor is implemented. With SBAS evolving towards L1-L5 dual-frequency multi-constellation direction, ionosphere-free smoothing is preferred for both ground and airborne data processing, saving the great effort of bounding the ionosphere correction. Due to the more pronounced CCI fault in the L5 signal compared to the L1 signal, its impact on user positioning is magnified. It has been analyzed that the presence of satellite clock failure CCI fault does not undermine the accuracy of the generated satellite corrections. However, to enhance the system availability, the satellite clock failure should be considered and a dual-frequency CCC monitor is required to monitor the measurements from both frequencies, while excluding the effects of ionosphere delay. One solution is to add another L1-like monitor for monitoring the additional L5 signal. Since only ionosphere-free errors need to be bounded in the dual-frequency system, an ionosphere-free monitor is another choice. Furthermore, a chi-squared monitor is proposed combining of three ionosphere-free statistics to monitor both frequencies simultaneously. These options are compared on the protected fault space and the performance on the probability of missed detection. It is concluded that the chi-squared monitor is an optimal choice, which protects user against an arbitrary CCI fault space excluding the ones with the form of ionosphere anomalies, and at the same time, achieves lower probability of missed detection than other monitors with the same fault magnitude.

Augmenting Three-Dimensional Model Annotation System with Enhanced Reality

This study proposes an augmented reality-based three-dimensional model annotation system, integrating cloud anchors, three-dimensional reconstruction, and augmented reality technology to achieve explicit three-dimensional annotations on models. Employing an improved ORB algorithm, the annotated model is persistently anchored in three-dimensional space through cloud anchors, presenting accurate spatial information and showcasing the depth of scenes and relationships between elements. The system supports multiple data types for annotations, such as text and images. Through a comparison with traditional two-dimensional annotation in a drone experiment, the system demonstrates higher experimental efficiency, providing more intuitive annotation guidance and enhancing remote guidance efficiency and user understanding of drones.

Clinical Application of an Augmented Reality Navigation System for Transforaminal Epidural Injection: A Randomized Controlled Trial.

Objectives: Augmented reality (AR) navigation systems are emerging to simplify and enhance the precision of medical procedures. Lumbosacral transforaminal epidural injection is a commonly performed procedure for the treatment and diagnosis of radiculopathy. Accurate needle placement while avoiding critical structures remains a challenge. For this purpose, we conducted a randomized controlled trial for our augmented reality navigation system. Methods: This randomized controlled study involved 28 patients, split between a traditional C-arm guided group (control) and an AR navigation guided group (AR-NAVI), to compare procedure efficiency and radiation exposure. The AR-NAVI group used a real-time tracking system displaying spinal structure and needle position on an AR head-mounted display. The procedural time and C-arm usage (radiation exposure) were measured. Results: All patients underwent successful procedures without complications. The AR-NAVI group demonstrated significantly reduced times and C-arm usage for needle entry to the target point (58.57 ± 33.31 vs. 124.91 ± 41.14, p < 0.001 and 3.79 ± 1.97 vs. 8.86 ± 3.94, p < 0.001). Conclusions: The use of the AR navigation system significantly improved procedure efficiency and safety by reducing time and radiation exposure, suggesting a promising direction for future enhancements and validation.

A domain decomposition solver for spectral stochastic finite element: an approximate sparse expansion approach

Spectral stochastic finite element (SSFE) has been widely used in the uncertainty quantification of real-life problems. However, the prohibitive computational burden prevents the application of the method in practical engineering systems because an enormous augmented system has to be solved. Although the domain decomposition method has been introduced to SSFE to improve the efficiency for the solution of the augmented system, there still exist significant challenges in solving the extended Schur complement (e-SC) system from domain decomposition method. In this paper, we develop an approximate sparse expansion-based domain decomposition solver to generalize the application of SSFE. An approximate sparse expansion is first presented for the subdomain-level augmented matrix so that the computational cost in each iteration of the preconditioned conjugate gradient is greatly alleviated. Based on the developed sparse expansion, we further establish an approximate sparse preconditioner to accelerate the convergence of the preconditioned conjugate gradient. The developed approximate sparse expansion-based domain decomposition solver is then incorporated in the context of SSFE. Since the difficulties of solving the e-SC system have been overcome, the developed approximate sparse expansion-based solver greatly improves the computational efficiency of the solution of the e-SC system, and thereby, the SSFE is capable of dealing with large-scale engineering systems. Two numerical examples demonstrate that the developed method can significantly enhance the efficiency for the stochastic response analysis of practical engineering systems.

An augmented reality-guided biopsy system using a high-speed motion tracking and real-time registration platform.

Biopsies play a crucial role in diagnosis of various diseases including cancers. In this study, we developed an augmented reality (AR) system to improve biopsy procedures and increase targeting accuracy. Our AR-guided biopsy system uses a high-speed motion tracking technology and an AR headset to display a holographic representation of the organ, lesions, and other structures of interest superimposed on real physical objects. The first application of our AR system is prostate biopsy. By incorporating preoperative scans, such as computed tomography (CT) or magnetic resonance imaging (MRI), into real-time ultrasound-guided procedures, this innovative AR-guided system enables clinicians to see the lesion as well as the organs in real time. With the enhanced visualization of the prostate, lesion, and surrounding organs, surgeons can perform prostate biopsies with an increased accuracy. Our AR-guided biopsy system yielded an average targeting accuracy of 2.94 ± 1.04 mm and can be applied for real-time guidance of prostate biopsy as well as other biopsy procedures.

A Fast and Interactive Augmented Reality System for PET/CT-guided Intervention of Neuroblastoma.

Neuroblastoma is the most common type of extracranial solid tumor in children and can often result in death if not treated. High-intensity focused ultrasound (HIFU) is a non-invasive technique for treating tissue that is deep within the body. It avoids the use of ionizing radiation, avoiding long-term side-effects of these treatments. The goal of this project was to develop the rendering component of an augmented reality (AR) system with potential applications for image-guided HIFU treatment of neuroblastoma. Our project focuses on taking 3D models of neuroblastoma lesions obtained from PET/CT and displaying them in our AR system in near real-time for use by physicians. We used volume ray casting with raster graphics as our preferred rendering method, as it allows for the real-time editing of our 3D radiologic data. Some unique features of our AR system include intuitive hand gestures and virtual user interfaces that allow the user to interact with the rendered data and process PET/CT images for optimal visualization. We implemented the feature to set a custom transfer function, set custom intensity cutoff points, and region-of-interest extraction via cutting planes. In the future, we hope to incorporate this work as part of a complete system for focused ultrasound treatment by adding ultrasound simulation, visualization, and deformable registration.

An In Vitro Study Demonstrating the Significance of Acromioclavicular Ligament Repair in Restoring Horizontal and Rotational Acromioclavicular Joint Stability.

The principle of joint reconstruction surgery is to try to recreate the native joint biomechanics and stability. With respect to acromioclavicular joint (ACJ) surgery, much focus to date has been on restoring the superoinferior stability. There is concern that persistent horizontal instability following ACJ reconstruction could lead to poorer patient outcomes; therefore, we evaluated whether acromioclavicular (AC) ligament repair offers improved horizontal stability in conjunction with ACJ reconstruction. A whole-body human cadaver was used. The ACJ was exposed and subjected to a constant 70N load on the lateral end of the clavicle to test the anteroposterior (AP), superoinferior (SI), and horizontal pivot angle (HPA) around the ACJ. The AC and coracoclavicular (CC) ligaments were subsequently divided, and the above three parameters were re-tested. Ligament augmentation and reconstruction system (Corin Group, Cirencester, UK), LockDown (LockDown Medical Limited, Redditch, UK), Endobutton (Smith and Nephew Inc.,London, UK), and Neoligament implant (Xiros Ltd., Leeds, UK) were used to reconstruct the CC ligaments and tested with and without AC repair. The native ACJ allowed an average 2.48 mm AP and 3.88 mm SI translation with a 27° HPA. All synthetic implants significantly improved the vertical stability of the ACJ but allowed up to a four-fold increase in AP translation. Coupled with ACJ repair, all the reconstructions were far superior, especially in restoring horizontal stability. The implants varied in their approach to fixation and concentrated primarily on the reconstruction of CC ligaments. Our study was able to demonstrate that AC repair significantly improves the stability of the construct and significantly reduces vertical and horizontal instability.

Observer-based resilient dissipativity control for discrete-time memristor-based neural networks with unbounded or bounded time-varying delays

This work focuses on the issue of observer-based resilient dissipativity control of discrete-time memristor-based neural networks (DTMBNNs) with unbounded or bounded time-varying delays. Firstly, the Luenberger observer is designed, and additionally based on the observed states, the observer-based resilient controller is proposed. An augmented system is presented by considering both the error system and the DTMBNNs with the controller. Secondly, a novel sufficient extended exponential dissipativity condition is obtained for the augmented system with unbounded time-varying delays by proposing a system solutions-based estimation approach. This method is based on system solutions and without constructing any Lyapunov–Krasovskii functionals (LKF), thereby reducing the complexity of theoretical derivation and computational workload. In addition, an algorithm is proposed to solve the nonlinear inequalities in the sufficient condition. Thirdly, the sufficient extended exponential dissipativity condition for the augmented system with bounded time-varying delays is also obtained. Finally, the effectiveness of the theoretical results is illustrated through two simulation examples.

Analysis and systematization of technical means and technologies of augmented reality in cartography

Relevance. In modern cartography, the introduction of advanced digital technologies is taking place continuously, increasing the quality and demand for cartographic products. One of such innovative directions is augmented reality technology, with which you can expand the content of the map using electronic mobile devices. The spread of augmented reality is facilitated by the widespread penetration of high-speed mobile Internet not only into large cities, but also in rural areas, as well as the reduction in the cost of electronic devices and services. Depending on the direction of application of augmented reality in cartography, the approach to the choice of software and hardware is changing. Aim. Analysis and systematization of the technical means and technologies of augmented reality in cartography. Objects. Augmented reality technologies in cartography, augmented reality technical means and their components. Methods. Content analysis of information on technologies, hardware and software for augmented reality in cartography. Results. The authors have analyzed hardware and software tools of augmented reality in cartography. They proposed the options for working with augmented reality in the form of scenario plans for three types of augmented reality in cartography: marker, markerless and spatial technologies. The minimum technical requirements of developers for the use of existing cartographic and navigation applications were highlighted. The paper considers a number of digital environments for implementation of augmented reality elements in cartography. The advantages of each of them were noted. The authors compiled a block diagram of a typical hardware-software complex of an augmented reality system in cartography and geoinformatics. They systematized types of sensors that solve geoinformation and cartographic tasks using augmented reality technologies.

Exploring mobility and transportation technology futures for people with ambulatory disabilities: A science fiction prototype

Although a number of studies have explored science fiction prototyping as a method for new product development, no study has ever used the method to examine the mobility and transportation technology needs of people with disabilities. The current research created a science fiction prototype, based on expert opinion expressed during an imagination workshop, which the authors then presented to a sample of people with ambulatory disabilities. Through a conjoint analysis, the sample members delineated the elements of the prototype they regarded as most important. The participants considered personal mobility assistive technology (either an automated wheelchair or an exoskeleton) the most important, followed by personal automation (autonomous [driverless] vehicle or personal robot) and thirdly by personal assistance technologies (real-time response versus augmented metaverse planning systems). Outputs to the conjoint analysis were clustered and three categories of individual emerged (i) more innovatively minded people who occupied the first cluster and preferred an exoskeleton, a personal robot and a subscription to the metaverse, (ii) people who appeared to be less technologically inclined and preferred an automated wheelchair, an autonomous vehicle and a subscription to a real-time assistive system, and (iii) a group with members favouring an AV but with few other predilections.

MiSleep: Human Sleep Posture Identification from Deep Learning Augmented Millimeter-wave Wireless Systems

In this work, we propose MiSleep , a deep learning augmented millimeter-wave (mmWave) wireless system to monitor human sleep posture by predicting the 3D location of the body joints of a person during sleep. Unlike existing vision- or wearable-based sleep monitoring systems, MiSleep is not privacy-invasive and does not require users to wear anything on their body. MiSleep leverages knowledge of human anatomical features and deep learning models to solve challenges in existing mmWave devices with low-resolution and aliased imaging and specularity in signals. MiSleep builds the model by learning the relationship between mmWave reflected signals and body postures from thousands of existing samples. Since a practical sleep also involves sudden toss-turns, which could introduce errors in posture prediction, MiSleep designs a state machine based on the reflected signals to classify the sleeping states into rest or toss-turn and predict the posture only during the rest states. We evaluate MiSleep with real data collected from Commercial-Off-The-Shelf mmWave devices for eight volunteers of diverse ages, genders, and heights performing different sleep postures . We observe that MiSleep identifies the toss-turn events start time and duration within 1.25 s and 1.7 s of the ground truth, respectively, and predicts the 3D location of body joints with a median error of 1.3 cm only and can perform even under the blankets, with accuracy on par with the existing vision-based system, unlocking the potential of mmWave systems for privacy-noninvasive at-home healthcare applications.

Non-neuronal cholinergic system in the heart influences its homeostasis and an extra-cardiac site, the blood-brain barrier.

The non-neuronal cholinergic system of the cardiovascular system has recently gained attention because of its origin. The final product of this system is acetylcholine (ACh) not derived from the parasympathetic nervous system but from cardiomyocytes, endothelial cells, and immune cells. Accordingly, it is defined as an ACh synthesis system by non-neuronal cells. This system plays a dispensable role in the heart and cardiomyocytes, which is confirmed by pharmacological and genetic studies using murine models, such as models with the deletion of vesicular ACh transporter gene and modulation of the choline acetyltransferase (ChAT) gene. In these models, this system sustained the physiological function of the heart, prevented the development of cardiac hypertrophy, and negatively regulated the cardiac metabolism and reactive oxygen species production, resulting in sustained cardiac homeostasis. Further, it regulated extra-cardiac organs, as revealed by heart-specific ChAT transgenic (hChAT tg) mice. They showed enhanced functions of the blood-brain barrier (BBB), indicating that the augmented system influences the BBB through the vagus nerve. Therefore, the non-neuronal cardiac cholinergic system indirectly influences brain function. This mini-review summarizes the critical cardiac phenotypes of hChAT tg mice and focuses on the effect of the system on BBB functions. We discuss the possibility that a cholinergic signal or vagus nerve influences the expression of BBB component proteins to consolidate the barrier, leading to the downregulation of inflammatory responses in the brain, and the modulation of cardiac dysfunction-related effects on the brain. This also discusses the possible interventions using the non-neuronal cardiac cholinergic system.

Multi-objective seismic optimization and evaluation of core-damper-frame tall buildings considering SSI effect

To control the seismic response of the core-frame (CF) structure and attenuate the stress level of the core tube, a novel core-damper-frame (CDF) system is proposed by decoupling the perimeter frame and the central core with flexible damper connectors. In this way, the large inertia force of the perimeter frame cannot be fully transmitted to the core, and the stress of the core is mitigated. In the meantime, the damper connectors would absorb a considerable amount of seismic energy, protecting the perimeter frame as the relative displacement between the two subsystems (perimeter frame and core tube) occurs. By incorporating the soil-structure-interaction (SSI) and the filtered Gaussian white-noise excitation model, the "excitation-soil-core-damper-frame" augmented system is established. Combing the augmented system and the genetic algorithm, a stochastic optimization procedure of the CDF considering the SSI effect is proposed. The optimization aims to minimize a series of performance objectives including displacement, acceleration, shear force, and overturning moment of the CDF system. The conflicting relationships between the multiple objectives are discussed; the influence of the SSI effect and the excitation parameters are evaluated. From an illustrative 40-story CDF structural example, the system shows great superiority in controlling the higher mode vibrations, and could significantly reduce the peak core acceleration (by 54.44 %), frame acceleration (by 56.48 %), core drift (by 28.83 %), frame drift (by 39.28 %), core shear (by 83.67 %), and frame moment (by 22.41 %), as compared to its conventional CF counterpart. In special, over 50 % of the input seismic energy is dissipated by the damper connectors in the CDF system.

Immunomodulation of Cancer Cells Using Autologous Blood Concentrates as a Patient-Specific Cell Culture System: A Comparative Study on Osteosarcoma and Fibrosarcoma Cell Lines.

The understanding that tumor cells might evade immunity through various mutations and the potential of an augmented immune system to eliminate abnormal cells led to the idea of utilizing platelet-rich fibrin (PRF), a blood concentrate containing the body's immune elements as an adjunctive therapy for localized tumors. This study is the first that evaluated the effect of PRF generated with different relative centrifugal forces (RCFs) on osteoblastic and fibroblastic tumor cell lines MG63 and HT1080 with regard to cell viability, cytokine and growth factor release, and the gene expression of factors related to the cell cycle and apoptosis. Our findings could demonstrate decreased cell proliferation of MG63 and HT1080 when treated indirectly with PRF compared to cell cultures without PRF. This effect was more distinct when the cells were treated with low-RCF PRF, where higher concentrations of growth factors and cytokines with reduced RCFs can be found. Similar patterns were observed when assessing the regulation of gene expression related to the cell cycle and apoptosis in both MG63 and HT1080 cells treated with PRF. Despite variations, there was a consistent trend of an up-regulation of tumor-suppressive genes and a down-regulation of anti-apoptotic genes in both cell types following treatment with high- and, particularly, low-RCF PRF formulations.

Application of augmented reality in physical rehabilitation

Augmented reality (AR) has become a popular multidisciplinary research field in recent decades. Augmented reality adds to the subject's real-world sensory information through computer-generated sound, text, and graphics that are projected into the user's natural visual and auditory fields to provide a real-time interactive experience in a common environment. A bibliographic review was carried out with the objective of updating the current state of the use of augmented reality in physical rehabilitation. Augmented reality systems consist of a user interface that offers a motivational component to patients to perform exercises, distracting them from the potential pain they may feel during exercises. Additionally, they can be implemented in the patient's home and eliminate frequent visits to rehabilitation clinics. Among the most used systems are ARS, RehaBio, NeuroR, AR Fruit Ninja, MirrARbilitation, SleeveAR, ARIS and BRU. Its uses have been focused mainly on post-surgical orthopedic and neurological rehabilitation in patients with strokes. Augmented reality offers significant benefits over in-person rehabilitation and other technologies such as virtual reality, which can speed up the recovery process and improve patients' quality of life

Current understanding of nociplastic pain.

Nociplastic pain by the "International Association for the Study of Pain" is defined as pain that arises from altered nociception despite no clear evidence of nociceptive or neuropathic pain. Augmented central nervous system pain and sensory processing with altered pain modulation are suggested to be the mechanism of nociplastic pain. Clinical criteria for possible nociplastic pain affecting somatic structures include chronic regional pain and evoked pain hypersensitivity including allodynia with after-sensation. In addition to possible nociplastic pain, clinical criteria for probable nociplastic pain are pain hypersensitivity in the region of pain to non-noxious stimuli and presence of comorbidity such as generalized symptoms with sleep disturbance, fatigue, or cognitive problems with hypersensitivity of special senses. Criteria for definitive nociplastic pain is not determined yet. Eight specific disorders related to central sensitization are suggested to be restless leg syndrome, chronic fatigue syndrome, fibromyalgia, temporomandibular disorder, migraine or tension headache, irritable bowel syndrome, multiple chemical sensitivities, and whiplash injury; non-specific emotional disorders related to central sensitization include anxiety or panic attack and depression. These central sensitization pain syndromes are overlapped to previous functional pain syndromes which are unlike organic pain syndromes and have emotional components. Therefore, nociplastic pain can be understood as chronic altered nociception related to central sensitization including both sensory components with nociceptive and/or neuropathic pain and emotional components. Nociplastic pain may be developed to explain unexplained chronic pain beyond tissue damage or pathology regardless of its origin from nociceptive, neuropathic, emotional, or mixed pain components.