Improvement of neuropathic pain related to spinal cord injury using combined transcranial direct current stimulation and neuromuscular electrical stimulation: a case report
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.007 | 0.004 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".