Phantom limb pain (PLP) is a complex medical condition that is often difficult to treat, and thus can become detrimental to patients’ quality of life. No standardized clinical treatments exist and there is no conclusive understanding of the underlying mechanisms causing it. Noninvasive brain stimulation (NIBS) has been used to find correlations between changes in brain activity and various brain conditions, including neurological disease, mental illnesses, and brain disorders. Studies have also shown that NIBS can be effective in alleviating pain. Here, we examined the literature on a particular type of NIBS, known as transcranial direct current stimulation (tDCS), and its application to the treatment of PLP. We first discuss the current hypotheses on the working mechanism of tDCS and then we examine published evidence of its efficacy to treat PLP. We conclude this article by discussing how tDCS alone, and in combination with brain imaging techniques such as electroencephalography (EEG) and magnetic resonance imagining, could be applied to further investigate the mechanisms underlying PLP.

In this paper, a full mandibular CT-scan in a specific patient is used to model BSSO surgery. The purpose is to compare the three most common fixation methods which are used in BSSO surgery by finite element method. Three different fixations are studied in order to obtain the minimum displacement of the lower jaw and optimum stress and strain on the specified fixation. The methods are two parallel plates with four screws, the operation of triangular screw configuration and one plate with four screws. The plates and the screw are modeled precisely by point clouds of Synthes Brand’s plate and screw. The mechanical properties of the full mandibular and, to obtain a practical model after the surgery, the mean jaw forces are extracted from literatures. It is resulted that the minimum displacement and stresses on the mandible and fixation tools happened in the Triangular screw configuration model and the two other methods have higher stress and lower displacement. Therefore, the mandibular in triangular method, experiences little deformation and the screws tolerates lower stress and strain which is better than the other two methods.

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IntroductionNeuropathic pain is a complex and demanding medical condition that is often difficult to treat. Regardless of the cause, the impairment, lesion or damage to the nervous system can lead to neuropathic pain, such as phantom limb pain (PLP). No treatment has been found widely effective for PLP, but plasticity-guided therapies have shown the least severe side effects in comparison to pharmacological or surgical interventions. Phantom motor execution (PME) is a plasticity-guided intervention that has shown promising results in alleviating PLP. The potential mechanism underlying the effectiveness of PME can be explained by the Stochastic Entanglement hypothesis for neurogenesis of neuropathic pain resulting from sensorimotor impairment. We have built on this hypothesis to investigate the efficacy of enhancing PME interventions by using phantom motor imagery to facilitate execution and with the addition of sensory training. We refer to this new treatment concept as Mindful SensoriMotor Therapy (MiSMT). In this study, we further complement MiSMT with non-invasive brain modulation, specifically transcranial direct current stimulation (tDCS), for the treatment of neuropathic pain in patients with disarticulation or peripheral nerve injury.Methods and analysisThis single-arm clinical trial investigates the efficacy of MiSMT and tDCS as a treatment of neuropathic pain resulting from highly impaired extremity or peripheral nerve injury in eight participants. The study consists of 12 sessions of MiSMT with anodal tDCS in the motor cortex, pretreatment and post-treatment assessments, and follow-up sessions (up to 6 months). The primary outcome is the change in pain intensity as measured by the Pain Rating Index between the first and last treatment sessions.Ethics and disseminationThe study is performed under the approval of the governing ethical committee in Sweden (approval number 2020-07157) and in accordance with the Declaration of Helsinki.Trial registration numberNCT04897425.

Neuropathic pain is a complex and demanding medical condition that is often difficult to treat. Regardless the cause of impairment, lesion or damage of the nervous system can lead to neuropathic pain, such as Phantom Limb Pain (PLP). No treatment has been found widely effective for PLP but guided plasticity therapies have shown the least severe side effects in comparison to pharmacological or surgical interventions. Phantom Motor Execution (PME) is a guided-plasticity intervention that has shown promising results alleviating PLP. The Stochastic Entanglement hypothesis suggests an origin for neuropathic pain resulting from sensorimotor impairment. In this study we build on this hypothesis to investigate the efficacy of enhancing PME interventions with the addition of sensory training. We refer to this concept as Mindful SensoriMotor Therapy (MiSMT), that in this study we further complement with non-invasive brain modulation, specifically transcranial Direct Current Stimulation (tDCS), for the treatment of neuropathic pain because of disarticulation or peripheral nerve injury.Methods and analysis This single-arm clinical trial investigates the efficacy MiSMT and tDCS as a treatment of neuropathic pain resulting from highly impaired extremity or peripheral nerve injury in eight participants. The study consists of 15 sessions of MiSMT with anodal tDCS in the motor cortex, pre- and post-treatment assessments, and follow-up sessions. The primary outcome is the change in pain intensity using the Pain Rating Index between the first and last session. Ethics and dissemination The study is performed under approval of the governing ethical committee in Sweden (approval number 2020-07157) and in accordance with the Declaration of Helsinki. Trial Registration Number NCT04897425