Source: https://patents.google.com/patent/US20110040362A1/en
Timestamp: 2018-06-24 22:03:41
Document Index: 675628800

Matched Legal Cases: ['application No. 60', 'application No. 60', 'application No. 60', 'application No, 60', 'application No. 60', 'application No. 60']

US20110040362A1 - Methods of Treating the Sacroiliac Region of a Patient's Body - Google Patents
US20110040362A1
US20110040362A1 US12912150 US91215010A US2011040362A1 US 20110040362 A1 US20110040362 A1 US 20110040362A1 US 12912150 US12912150 US 12912150 US 91215010 A US91215010 A US 91215010A US 2011040362 A1 US2011040362 A1 US 2011040362A1
US12912150
US8864759B2 (en )
Methods of treating the sacroiliac region of a patient's body by delivering energy are described. In some embodiments, the method comprises the steps of: inserting at least one probe into the sacroiliac region, the probe comprising at least one energy delivery device: positioning the at least one energy delivery device adjacent material to be treated; and delivering energy through the at least one energy delivery device to create a longitudinal strip lesion; wherein the at least one energy delivery device remains in a substantially static position during creation of the strip lesion. In some embodiments, energy may be delivered to treat at least two branches of the sacral nerves or to create an intra-articular lesion.
This application claims the benefit of: U.S. provisional application No. 60/627,813, filed Nov. 15, 2004; U.S. provisional application No. 60/593,839, filed Feb. 17, 2005; U.S. provisional application No. 60/594,787, filed May 5, 2005; U.S. provisional application No, 60/595,426, filed Jul. 4, 2005; U.S. provisional application No. 60/595,559, filed Jul. 14, 2005; and U.S. provisional application No. 60/595,560, filed Jul. 14, 2005. The aforementioned applications are all herein incorporated by reference.
Ferrante et al. (Radiofrequency Sacroiliac Joint Denervation for Sacroiliac Syndrome; Regional Anaesthesia and Pain Medicine, Vol. 26, No. 2, pp. 137-142, March-April 2001, which is incorporated herein by reference) describe the creation of a strip lesion along the long axis of the posterior sacroiliac (SI) joint using RF energy. Multiple probes are inserted along the joint margin and energy is delivered in a bipolar configuration. Such an approach requires multiple probe insertions and requires relatively precise probe placement in order to ensure adequate lesioning between the bipolar probes. Gevargez et al, (CT-Guided Percutaneous Radiofrequency Denervation of the Sacroiliac Joint; Eur Radiol (2002) 12:1360-1365, which is incorporated herein by reference) describe the creation of a strip lesion through the interosseous ligament surrounding the SI joint using RF energy. This approach, as detailed therein, requires multiple energy delivery and repositioning steps and does not allow for the creation of a lesion within the intra-articular space of the SI joint itself. Yin et al. (Sensory Stimulation-Guided Sacroiliac Joint Radiofrequency Neurotonomy: Technique based on Neuroanatomy of the Dorsal Sacral Plexus; (2003) SPINE, Vol. 28, No. 20, pp. 2419-2425, which is incorporated herein by reference) advocate lesioning a single branch of a sacral nerve as it exits the sacral foramina. The procedure described by Yin et al. may require a relatively skilled user due to the approach involved. In addition, the procedure detailed therein is time consuming as it involves multiple steps of probe re-positioning and neural stimulation in order to locate a single symptomatic nerve branch. Furthermore, this procedure does not allow for the creation of a strip lesion nor does it allow for the creation of a lesion within the SI joint. Thus, it would be desirable to have a procedure to treat the SI region using energy delivery that overcomes some or all of the limitations of the prior art.
In addition, in the context of the present invention, the term ‘probe’ is used to describe any elongate device comprising an energy delivery device which may be percutaneously inserted into a patient's body. These devices include but are not limited to catheters, cannulae and electrosurgical probes. For the sake of clarity, the term ‘probe’ is, used throughout the specification to describe any such device.
Pain or other symptoms (described below) associated with or emanating from the sacroiliac region, including the SI joint and the surrounding region, have been referred to in the literature as sacroiliac syndrome, sacroiliac joint dysfunction or sacroiliac joint complex (SIJC) pain, amongst other terms, and, for clarity, will be referred to throughout this specification as sacroiliac joint syndrome (SUS). Symptoms of sacroiliac joint syndrome may include, but are not limited to: pain, stiffness and tingling.
With respect to the present invention, one broad method of treating the sacroiliac region of a patient's body by delivering energy may comprise the following steps: inserting at least one probe into the sacroiliac region, the probe comprising at least one energy delivery device; positioning the at least one energy delivery device adjacent material to be treated; and delivering energy through the at least one energy delivery device to create a longitudinal strip lesion; wherein the at least one energy delivery device remains in a static position during creation of the strip lesion. These steps will be discussed in detail in the description of various embodiments below. More specific methods of treating SIJS can be grouped into two categories: those methods that rely on access to at least a portion of the SI joint itself or the immediate vicinity and those that perform a procedure at some other location in the SI region wherein the procedure results in a reduction of SIJS symptoms associated with the SI region (these symptoms may be directly emanating from the SI region or they may have their source in the SI region but be referred to a different region of the body). These two approaches will be presently described in sufficient detail so as to enable one skilled in the art to perform such procedures to treat SUS.
More specifically, a first embodiment of the method comprises the steps of: inserting at least one elongated probe into or adjacent the SI joint and delivering energy through the probe(s), wherein the energy may be delivered in order to ablate tissue. Lesioning by ablation can for example be effected using an RF signal having a voltage up to 500V, current up to 5 amps, a frequency of 100 kHz to 10 MHz and an application interval of 5 seconds to 30 minutes; for tissue in the sacroiliac region, the signal may, in some embodiments, have a voltage ranging between 10V and 100V, a frequency of 400-550 kHz, an application interval of 1 to 10 minutes, and a power of 1-20 Watts. In the embodiment shown in FIG. 2A, a probe 220, comprising a distal region 224 and a proximal region (not shown), is inserted into the intra-articular space (also referred to as the joint space) 201 of the SI joint 200. In such an embodiment, probe 220 may comprise an energy delivery device 226 associated with distal region 224, and probe 220 may be operable in a monopolar configuration in conjunction with a grounding pad (not shown) placed at some location on the surface of the patient's body. Preferably, probe 220 is capable of creating a strip lesion 230 within SI joint 200, in order to treat as much of the joint as possible within a single treatment procedure. Because the SI joint 200 is difficult to access, the ability to create a strip lesion to treat a large area with the insertion of only one probe is desirable in some situations. For example, a strip lesion having its longest dimension parallel to the longitudinal axis of the energy delivery device may have a length:width and/or length:depth ratio of approximately 3:1, i.e. the length substantially exceeds one or more of the width and/or the depth. Alternatively, another example of a strip lesion is a lesion that has its longest dimension on any axis other than an axis parallel to the longitudinal axis of the energy delivery device. Such a lesion may be created substantially between two or more probes, for example in a bipolar configuration. Alternatively, such a lesion may be created by a single probe. However, the ability to create a strip lesion is not necessary and, in alternate embodiments, the probe may indeed not be required to create or even capable of creating a strip lesion. Rather, various probes, capable of producing lesions of various shapes and sizes, may also be used in conjunction with this method aspect of the present invention and the invention is not limited in this regard.
Referring now to the steps in detail, the step of inserting at least one elongated probe may comprise penetrating into the joint using one or more rigid introducer tubes 210 or other insertional apparatus, and inserting the probe(s) through the introducer(s). Penetration into the joint may also be facilitated by the use of a sharp or pointed probe(s), by the use of a stylet, by the insertion of a guide wire or by any other insertional method or device and the invention is not limited in this regard. It should also be noted that the introducer(s) or other means for insertion may or may not be electrically and/or thermally insulated and they may be curved or straight. In the context of the present invention, the term ‘curved’ is taken to refer to a deviation from the longitudinal axis of the device. A curved introducer may take several forms and the invention is not limited in this regard. For example, it may be curved along a substantial portion of its radius or it may have a bent tip, wherein the rest of the introducer may be straight. Furthermore, the length and diameter of the introducer are not limited to specific values and any suitably sized introducer may be used. For clarity, the term introducer will be used throughout this specification and is intended to encompass any device that may facilitate entry of the probe into a specific site within the body of a patient. In embodiments that include such devices, these devices may be capable of penetrating into a patient's body as well as penetrating through one or more of the ligaments surrounding the SI joint. In alternate embodiments, the probe may be positioned at the appropriate location within a patient's body without using any additional means to facilitate insertion.
More specifically, and with reference still to FIG. 2A, introducer 210 may be inserted percutaneously about 1-3 cm below the inferior margin 204 of SI joint 200 and guided anterio-cranially until the tip 212 contacts the ilium about 1 cm above inferior margin 204. Introducer 210 may then be manipulated until a tip of introducer 210 enters the joint space. Probe 220 may then be guided through introducer 210 until a tip of probe 220 enters intra-articular space 201. Probe 220 may then be further advanced to traverse intra-articular space 201 of SI joint 200. Once probe 220 is properly positioned, energy may be applied to create a strip lesion 230 within SI joint 200. In an alternative embodiment, and with reference now to FIG. 2B, introducer 210 may be initially manipulated so that the introducer tip 212 is placed just superior to the most posterior point of inferior margin 204. Probe 220 may then be guided through introducer 210 and advanced along the posterior side of the posterior margin 206 of SI joint 200 (outside the joint). Once probe 220 is properly positioned, energy may be applied to create a strip lesion 230 outside and/or within the joint (i.e. the lesion may or may not extend into the intra-articular space 201 of the joint 200). In a further alternative of this treatment procedure, illustrated in FIG. 2C, introducer 210 is manipulated until a tip 212 of introducer 210 enters intra-articular space 201 at the most caudal point of the anterior-inferior margin 208 of SI joint 200. Probe 220 may then be guided through introducer 210 and along the posterior side of the anterior margin 209 of SI joint 200 (inside the joint). Once probe 220 is properly positioned, energy may be applied to create a strip lesion 230 along the anterior side of SI joint 200. In any of these embodiments, the introducer 210 may be inserted some distance into the SI joint 200.
Referring now to the step of delivering energy through the probe(s), this may be accomplished by providing, for example, a generator, operable to deliver radiofrequency (RF) energy in the range of for example about 100 kHz to about 1 GHz, connecting the generator to the probe(s) and operating the generator to deliver said RF energy to the SI joint through an energy delivery device associated with a distal region of the probe(s). A generator that may be used to perform these treatment methods, by way of non-limiting example, is the Pain Management Generator (PMG) from Baylis Medical Company Inc., Montreal, QC, Canada. Features of this generator are described in co-pending U.S. patent application Ser. Nos. 10/122,413, filed on Apr. 16, 2002; 10/323,672, filed on Dec. 20, 2002; 10/864,410, filed on Jun. 10, 2004; 10/893,274, filed on Jul. 19, 2004; and 11/198,099, filed on Aug. 5, 2005. All of the aforementioned applications are incorporated herein by reference. In one embodiment, the generator is operable to deliver sufficient energy to the target tissue through the probe(s) so that tissue within or adjacent to the SI joint may be ablated, as has been defined earlier. In such embodiments that involve the ablation of a region of tissue, the tissue ablated according to this aspect of the invention can include, but is not limited to, one or more of: neural tissue, whose ablation can prevent the transmission of pain sensation; structural or connective tissue, whose ablation can cause a contraction of collagen and a reduction in the volume of the intra-articular space of the joint; and vascular tissue, whose ablation may result in the disruption of nutrient supply to one or more neural structures. In alternate embodiments, the energy delivered by the generator through the probe(s) may not ablate tissue but may perform one or more other treatment functions, such as altering the structure of collagen (without causing cellular coagulation) or globally heating the joint, thereby altering the function of neural tissue, without necessarily ablating or destroying the nerves themselves. Thus, the function of neural tissue may be altered with or without ablating the neural tissue. Other alternative treatment functions may include, but are not limited to, denaturing enzymes or increasing heat shock proteins in the SI joint. Alternatively, RF (or other) energy could be delivered in a series of amplitude or frequency modulated pulses, whereby tissue heating is inhibited by interrupting periods of energy delivery with relatively long periods in which no energy is delivered. By pulsing the energy in this manner, a voltage that is sufficiently high to affect a prolonged disruption of the function of neural tissue may be used, while maintaining the tissue at a temperature such that no lesion will form, or such that the formation of a lesion will be inhibited. In further embodiments, a generator may not be used. In these embodiments, energy may be generated by a battery or any other means (in which case the entire system [probe and energy source] may be hand-held/portable/modular) and the invention is not limited in this regard. Without limitation, any delivery of energy that may result in a treatment effect to alleviate symptoms of SIJS is intended to be included within the scope of this aspect of the present invention.
As mentioned above, in some embodiments, the probe(s) may be operable to create a single strip lesion within the joint. In addition, the probe(s) may be operable to create such a lesion during the course of a single energy delivery step, without the need for one or more of removal of the probe(s), reinsertion of the probe(s) or intentional repositioning of the probe(s). In other words, the probe may remain in a substantially static position during the creation of the strip lesion. It should be noted, however, that creating strip lesions through one or more probe repositioning or energy delivery steps, as well as creating individual, non-strip lesions, also fall within the scope of this invention.
In addition, although the aforementioned embodiments have been described using only one probe, several probes may be used in order to deliver energy within the SI joint. Furthermore, each of these probes may comprise one or more energy delivery devices and the invention is not limited in this regard. For example, in alternate embodiments, two or more probes may be used in a bipolar configuration. In some such embodiments, the probes may be spaced apart by a distance that is not greater than about five times the diameter of the energy delivery devices located on the probes. Such a spacing may be advantageous when using non-cooled probes. Using cooled probes, as discussed below, may allow for a larger separation distance between the probes. In addition, in some embodiments, the probes may be separated by a distance of at least about 1 cm. In other embodiments, probe separation may vary and may be more or less than the aforementioned maximum and minimum distances. In yet further embodiments, three or more probes may be used in a triphasic configuration. It should be noted that when more than one probe is used, the probes may be operated in a monopolar configuration and the invention is not limited in this regard. For example, several probes may be operated in a monopolar configuration, whereby a specific lesion shape may be obtained by determining an optimal spacing between probes that may produce a specific interference pattern and thus, a specific current density resulting in a desired lesion shape.
In use, and with reference again to FIGS. 2A to 2C, a first embodiment of this aspect of a method of the present invention may be practiced as follows: a patient is made to lie prone on an operating table or similar structure, a grounding pad is placed on the surface of the patient's body and local anesthetic is provided in the area to be treated (for example, at or near the SI joint). If neural stimulation will be performed, as discussed below, the stimulation step may be performed prior to the delivery of anesthetic (if anesthetic is used). Prior to the insertion of the probe(s) or introducer(s), fluoroscopic imaging or other means may be used to visualize a patient's sacroiliac region in order to ascertain the desired approach for inserting the device(s) into the SI joint. This is particularly important with respect to SIJS treatment procedures because the anatomical structures involved may vary significantly from patient to patient. Various angles of approach and sites of entry may be used and the invention is not limited in this regard. After introducer 210 has been inserted, the position of introducer 210 may be verified using fluoroscopic imaging (or other imaging modalities) or other means, after which probe 220 may be inserted through a bore or lumen of introducer 210 such that at least a portion of distal region 224 of probe 220 is located within or adjacent to joint 200, depending on the specific target lesion site. It should be noted that, in those embodiments that comprise a stylet to facilitate positioning of the probe, the stylet may be located within an introducer and may be removed from the introducer prior to insertion of the probe. In some embodiments, as shown in FIG. 2A, probe 220 is advanced far enough into joint 200 so that a strip lesion 230 will be created across a substantial part of the long axis of joint 200 when energy is delivered to energy delivery device 226. Probe 220 may be advanced until further advancement is impeded by an anatomical structure, such as a bone or a ligament. It may be desirable that probe 220 be inserted into joint 200 in such a way so as to minimize damage to the connective tissues of the joint, including the articular cartilage located at the surfaces of the bones, as well as the various ligaments associated with joint 200. Therefore, in order to avoid damaging these tissues, the probe may be inserted into the cartilaginous space 207 of joint 200, as shown in FIG. 2A, in which case it would be desirable to have a probe flexible enough to conform to the boundaries of cartilaginous space 207. In addition, some embodiments may utilize a probe capable of creating a relatively thin strip lesion (i.e. a strip lesion with a small diameter or a strip lesion with short minor axes) so that the lesion does not extend too deeply into the cartilage. Depending on the specific probe that is used, a user may receive tactile feedback to indicate that the probe is contacting cartilage or ligamentous tissue and the user may then decide to retract the probe slightly and attempt to reposition the probe. In alternate embodiments, a probe may be introduced into the SI joint without being inserted into the cartilaginous space, for example in order to reach certain nerves which may be located throughout the joint, for example as shown in FIG. 2B. In general, when inserting probe 220 into joint 200, care should be taken to insert the probe as far as possible into joint 200 while minimizing the collateral damage to the tissues that make up the joint. In other embodiments, the probe may not initially extend a large distance into the joint, in which case smaller lesions may be made while advancing the probe slowly through the joint space in order to treat as much of the joint space as possible. In yet further embodiments, it may be desirable to have at least a portion of the probe located proximate to or within a region of cartilage. For example, this may be desirable if it is suspected that a fissure or other defect exists within the cartilage, in which case it may be beneficial to apply energy directly to the cartilage in order to heal the fissure or other defect. At this point, energy may be delivered from a generator via energy delivery device 226 to tissue of SI joint 200. If the probe is steerable, the probe tip may be maneuvered into a second location within the joint and energy may again be delivered to ablate the neural tissue at the second location. This may be repeated as many times as the user wishes. If the probe is not steerable, the probe may be removed from the joint and/or the patient and the positioning and insertion steps may be repeated so that the probe is located at a second position, at which point energy may be delivered again at this location. Once the user has determined that enough neural tissue has been ablated or otherwise affected, the introducer and probe may be removed from the body and the patient should be allowed to recover. It should be noted that this description is intended to be exemplary only and that other embodiments are envisioned as well. In addition, this invention is not intended to be limited by the number and type of probes used in this and other embodiments as well as the number and type of lesions created by these probes. It is also important to note that the aforementioned embodiments have been described with reference to a typical structure of an SI joint, as can be found in the literature. However, the SI joint is known to be extremely variable and the structures discussed with respect to this preferred embodiment may not be present in some individuals or may be located in different areas of the joint. Thus, the present invention is not intended to be limited by these embodiments.
In accordance with a second aspect of the present invention, a method for the treatment of SUS by performing a treatment procedure outside of the SI joint is provided. The method generally comprises the steps of inserting a device into a region of tissue external to the SI joint in a patient's body and performing a treatment operation in order to reduce one or more symptoms associated with SUS. For example, a treatment procedure of this method aspect may be performed proximate to a patient's sacral region, within one or more of the SI ligaments or in a region of tissue adjacent to one or more nerves that innervate the SI joint. These locations are exemplary only and are not intended to limit the present invention in any way. The scope of this aspect of the present invention is intended to cover any treatment procedures performed external to the SI joint that fall within the limitations of the appended claims. This approach is beneficial because it may allow for a treatment procedure that can effectively target neural tissue that innervates the SI joint without having to actually enter the joint itself. Furthermore, if a patient's pain is emanating from the SI joint ligaments, it may be beneficial to target the neural tissue before it reaches the ligaments in order to alleviate this pain. In addition, energy may be delivered to connective tissue in the SI region (such as, for example, one of the sacroiliac ligaments) in order to, for example, tighten or loosen the tissue. Generally, it may be beneficial to treat neural tissue as close to the nerve root as possible, in order to increase the effectiveness of the treatment procedure.
Similar to what has been discussed with respect to the first aspect of the present invention, a first embodiment of the second aspect generally comprises the steps of inserting one or more probes into a region of tissue in a patient's body and delivering energy through the probe(s) in order to relieve symptoms of SUS, wherein the energy may be delivered, for example, in order to ablate tissue. In the embodiment shown in FIG. 1, a probe 120, comprising a distal region 124 and a proximal region (not shown), is inserted proximate to sacrum 100. In this embodiment, probe 120 comprises an energy delivery device 126 associated with distal region 124, and probe 120 may be operable in a monopolar configuration in conjunction with a grounding pad (not shown) placed at some location on the surface of the patient's body. Probe 120 may be capable of creating a strip lesion 130 adjacent sacrum 100, in order to treat as many neural structures of the dorsal sacral plexus as possible within a single treatment procedure. However, the ability to create a strip lesion is not necessary in some embodiments. Rather, various probes, capable of producing lesions of various shapes and sizes, may also be used in conjunction with this aspect of the present invention and the invention is not limited in this regard.
At this point, and with reference again to FIG. 1, the position of introducer 116 may be verified using fluoroscopic imaging (or other imaging modalities) or other means, after which probe 120 may be inserted through a bore or lumen of introducer 116 such that at least a portion of distal region 124 of probe 120 is located adjacent to and along sacrum 100. It should be noted that, in those embodiments that comprise a stylet to facilitate positioning of the probe, the stylet may be located within an introducer and may be removed from the introducer prior to insertion of the probe. As shown in FIG. 1, probe 120 may be advanced to the extent that elongate strip lesion 130 will be created around probe 120 across a substantial part of the dorsal sacral plexus when energy is delivered to energy delivery device 126. In this embodiment, it may be beneficial to use a flexible probe which is capable of conforming to the surface of sacrum 100. In other embodiments, the probe may extend various distances outside of the introducer and the invention is not limited in this regard. For example, if using a brush electrode comprising a plurality of electrically conductive filamentary members, an effective strip lesion may be created by dragging the probe along a tissue while supplying energy to the filaments, analogous to painting with a paint brush. In such an embodiment, the probe may be extended from the introducer such that a distal end of the probe may be located adjacent to the S1 sacral nerve of the sacral posterior rami, so that, when the probe is retracted back into the introducer, a lesion will be created covering all of the nerves between the S1 level and the location of the introducer.
inserting at least one probe into said sacroiliac region, the probe comprising at least one energy delivery device;
positioning said at least one energy delivery device adjacent material to be treated; and
delivering energy through said at least one energy delivery device to create a strip lesion substantially parallel to at least a portion of a longitudinal axis of said at least one energy delivery device while said at least one energy delivery device remains in a substantially static position.
2. The method of claim 1, wherein energy is delivered in order to reduce one or more symptoms of sacroiliac joint syndrome.
3. The method of claim 2, wherein said one or more symptoms of sacroiliac joint syndrome comprises one or more of: pain, stiffness and tingling.
4. The method of claim 1, wherein energy is delivered in order to alter the structure or function, or both, of neural tissue.
5. The method of claim 4, wherein the step of delivering energy comprises delivering energy so as to ablate one or more neural structures.
6. The method of claim 1, wherein energy is delivered in order to treat connective tissue of said sacroiliac region.
7. The method of claim 6, wherein the step of inserting at least one probe comprises positioning said at least one energy delivery device within one or more sacroiliac ligaments and wherein energy is delivered in order to tighten or loosen the ligaments.
8. The method of claim 1, wherein said at least one probe comprises at least two energy delivery devices and wherein energy is delivered in a bipolar configuration.
9. The method of claim 1, wherein said at least one probe comprises at least three energy delivery devices and wherein energy is delivered in a triphasic configuration.
10. The method of claim 1, wherein the step of delivering energy comprises delivering energy selected from the group consisting of: electromagnetic energy ranging from radio-frequency energy to optical energy, thermal energy, and ultrasonic energy.
11. The method of claim 10, wherein the step of delivering energy comprises delivering radio-frequency energy in a series of pulses modulated by one or more of frequency and amplitude.
12. The method of claim 1, wherein the step of positioning said at least one energy delivery device comprises positioning said at least one energy delivery device in proximity to a surface of the sacrum of said patient's body.
13. The method of claim 12, wherein said at least one energy delivery device is positioned in proximity to at least one posterior sacral foramina.
14. The method of claim 1, further comprising a step of delivering energy at a physiological stimulation frequency through said at least one energy delivery device in order to stimulate one or more neural structures.
15. The method of claim 1, further comprising a step of monitoring temperature of a tissue in said patient's body.
16. The method of claim 1, further comprising a step of monitoring impedance of a tissue in said patient's body.
17. The method of claim 1, further comprising a step of modifying a treatment parameter selected from the group consisting of: maximum allowable temperature, rate of coolant flow and temperature ramp rate.
18. The method of claim 17 wherein the step of modifying a treatment parameter occurs in response to a measured temperature.
19. The method of claim 1, further comprising a step of actively cooling at least one of said at least one energy delivery devices.
US12912150 2004-11-15 2010-10-26 Methods of treating the sacroiliac region of a patient's body Active 2027-01-26 US8864759B2 (en)
US20110040362A1 true true US20110040362A1 (en) 2011-02-17
US8864759B2 US8864759B2 (en) 2014-10-21
CA2959332A1 (en) * 2014-08-26 2016-03-03 Avent, Inc. Method and system for identification of source of chronic pain and treatment