Systems, compositions, and methods for local imaging and treatment of pain

Abstract

Pain factors are labeled with targeted agents or markers delivered into the body. The labeled pain factors are imaged with appropriate imaging tools in a manner allowing selective identification and localization of areas of pain source or transmission. The labeled pain factors allow spatial differentiation in the imaging sufficient to specify the location of the pain so as to drive therapeutic decisions and techniques in order to treat the pain. Pain factors labeled and imaged in this manner may include one or more of nerve factors, blood vessel factors, cellular factors, and inflammation factors. Labeled markers may include for example radioactive materials (e.g. tritiated or iodinated molecules) or other materials such as metal (e.g. gold) nanoparticles. Intermediary binding materials may be used, such as for example bi-specific antibodies. Therapeutic components of the system and method include for example localized energy delivery or ablation treatments, or local drug or other chemical delivery. Locations containing pain factor selectively bound by targeted agents are selectively treated with directed energy into a region containing the targeted agent bound to the pain factor.

1 . (canceled) 
     
     
         2 . A method of treating back pain of a patient, the method comprising:
 delivering a substantially targeted agent that is adapted to differentially bind to a pain factor into or adjacent a vertebral endplate of a vertebra of the patient;   wherein the targeted agent is conjugated with an imaging contrast label to thereby form a targeted label configured to artificially label the pain factor in a manner substantially increasing an ability to image the pain factor with a magnetic resonance imaging (“MRI”) tool;   imaging, with the MRI tool, the targeted label coupled to the pain factor;   determining whether the vertebral endplate is a pain source based on the imaging;   channeling a path toward a target treatment location within bone of a vertebral body of the vertebra using an introducer;   delivering a therapeutic device through the introducer to the target treatment location within the bone of the vertebral body;   wherein the therapeutic device comprises a delivery probe with an elongated body;   wherein the therapeutic device is adapted to ablate nerve tissue; and   using the therapeutic device, ablating a basivertebral nerve at the target treatment location within the bone of the vertebral body.   
     
     
         3 . The method of  claim 2 , wherein the delivery probe comprises an ultrasound probe configured to deliver ultrasound energy. 
     
     
         4 . The method of  claim 2 , wherein the delivery probe comprises a radiofrequency probe configured to deliver electrical energy. 
     
     
         5 . The method of  claim 4 , wherein the radiofrequency probe comprises first and second electrodes in a bipolar lead assembly arrangement. 
     
     
         6 . The method of  claim 2 , wherein the delivery probe is configured to deliver microwave energy. 
     
     
         7 . The method of  claim 2 , wherein the delivery probe is configured to deliver at least one therapeutic chemical. 
     
     
         8 . The method of  claim 2 , wherein the therapeutic device is configured to deliver thermal energy. 
     
     
         9 . The method of  claim 2 , wherein the imaging contrast label comprises an MRI contrast agent. 
     
     
         10 . The method of  claim 2 , wherein the pain factor comprises a nerve factor. 
     
     
         11 . The method of  claim 2 , wherein the pain factor comprises an inflammatory factor. 
     
     
         12 . The method of  claim 2 , wherein the pain factor comprises a cellular factor. 
     
     
         13 . A method of treating back pain of a patient, the method comprising:
 delivering a substantially targeted agent that is adapted to differentially bind to a pain factor into or adjacent a vertebral endplate of a vertebra of the patient;   wherein the targeted agent is conjugated with an imaging contrast label to thereby form a targeted label configured to artificially label the pain factor in a manner substantially increasing an ability to image the pain factor with an imaging tool; imaging, with the imaging tool, the targeted label coupled to the pain factor;   determining whether the vertebral endplate is a pain source based on the imaging;   channeling a path toward a target treatment location within bone of a vertebral body of the vertebra using an introducer;   delivering an energy delivery assembly through the introducer to a position at or adjacent the target treatment location within the bone of the vertebral body;   wherein the energy delivery assembly is adapted to deliver a therapeutic dose of energy in a substantially localized manner that is substantially isolated to the target treatment location; and   wherein the therapeutic dose of energy is sufficient to ablate nerve tissue; and using the energy delivery assembly, ablating an intraosseous nerve at the target treatment location within the bone of the vertebral body.   
     
     
         14 . The method of  claim 13 , wherein the energy delivery assembly comprises a radiofrequency probe configured to deliver the therapeutic dose of energy. 
     
     
         15 . The method of  claim 14 , wherein the radiofrequency probe comprises first and second electrodes in a bipolar lead assembly arrangement. 
     
     
         16 . The method of  claim 13 , wherein the therapeutic dose of energy is thermal energy. 
     
     
         17 . The method of  claim 13 , wherein the imaging tool is a magnetic resonance imaging (“MRI”) tool and wherein the imaging contrast label comprises an MRI contrast agent. 
     
     
         18 . The method of  claim 13 , wherein the pain factor comprises an inflammatory factor. 
     
     
         19 . A method of treating back pain of a patient, the method comprising:
 delivering a substantially targeted agent that is adapted to differentially bind to a pain factor into or adjacent a vertebral endplate of a vertebra of the patient;   wherein the targeted agent is conjugated with an imaging contrast label to thereby form a targeted label configured to artificially label the pain factor in a manner substantially increasing an ability to image the pain factor with an imaging tool;   imaging, with the imaging tool, the targeted label coupled to the pain factor;   determining a pain source based on the imaging;   channeling a path toward a target treatment location within bone of a vertebral body of the vertebra using an introducer;   delivering a therapeutic device through the introducer to the target treatment location within the bone of the vertebral body;   wherein the therapeutic device is adapted to deliver a therapeutic dose of energy to the target treatment location;   wherein the target treatment location comprises an intraosseous nerve.   
     
     
         20 . The method of  claim 19 :
 wherein the therapeutic device comprises a radiofrequency probe having first and second electrodes in a bipolar lead assembly arrangement;   wherein the therapeutic dose of energy comprises electrical energy or thermal energy;   wherein the imaging tool comprises a magnetic resonance imaging (“MRI”) tool; and   wherein the imaging contrast label comprises an MRI contrast agent.   
     
     
         21 . The method of  claim 19 , wherein the pain factor comprises an inflammatory factor.