Improvement of neuropathic pain related to spinal cord injury using combined transcranial direct current stimulation and neuromuscular electrical stimulation: a case report
Notice bibliographique
Résumé
Case presentation: A 32 Y.O. male with neuropathic pain from a T12/L1 traumatic spinal cord injury (SCI) since 2019 underwent a weekly protocol of combined transcranial Direct Current stimulation (tDCS) at 2mA targeting the motor precentral region and 20 minutes of functional electrical stimulation of the bilateral femoral quadriceps. Initial comprehensive assessments of pain and quality of life were conducted using the Neuropathic Pain Symptoms Inventory (NPSI), McGill Pain Questionnaire (MPQ), Pain Quality Assessment Questionnaire (PQAS), Short-form Health Survey-36 (SF36), and Quality of Life Index Spinal Cord Injury III (SCI III). The American Spinal Cord Injury Association Impairment Scale (AIS) evaluated his spinal cord status. After 12 weeks, these assessments were repeated. The study was approved by the institution’s Ethics Committee, and the patient provided written consent. By the end, AIS level and classification remained unchanged, and no side effects were reported. There was a reduction in deep and superficial pain, with evoked and continuous pain remaining stable. Paroxysmal pain showed contradictory results between PQAS and NPSI, precluding definitive conclusions. MPQ showed a 50% reduction in the affective component of pain. Significant improvements in quality of life and functionality metrics were observed in SCI III, along with enhancements in all dimensions of SF-36, some of which were notably enhanced. The questionnaire revealed significant improvements in vitality, sociability, physical condition, and pain, enhancing daily performance and capabilities. Pain characteristics became more benign, with alterations in type, and both recurrence and duration of pain decreased. Discussion: Neuropathic pain is a common issue in individuals with SCI, resulting from damage to the somatosensory system leading to neuronal hyperexcitability. Drug-based treatments for neuropathic pain tend not to have satisfactory effects. The intervention reduced some somatosensory pain features while others remained stable. However, the substantial improvement in quality of life suggests an objective decrease in pain through indirect measures, which may be more practical than analog scales. The neuropathic pathophysiology of pain in SCI involves central sensitization, which tDCS may modulate, partially explaining the results. Since chronic pain impacts quality of life through negative emotions, this case report suggests that combined stimulation may modulate the emotional response to pain, not just its sensory characteristics. The decreased recurrence and duration of pain may be related to the patient’s improved well-being. Final comments: The therapy was safe and feasible, resulting in substantial improvements in quality of life. Therefore, this approach could fill a gap in patient care, given the lack of effective drug-based treatments for neuropathic pain. This case report highlights the importance of future experimental trials with combined neurostimulation.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,003 | 0,001 |
| Méta-épidémiologie (sens large) | 0,002 | 0,002 |
| Bibliométrie | 0,003 | 0,003 |
| Études des sciences et des technologies | 0,003 | 0,002 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,002 | 0,002 |
| Intégrité de la recherche | 0,007 | 0,004 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».