<p>Combining Transcranial Direct Current Stimulation and Transcutaneous Electrical Nerve Stimulation to Relieve Persistent Pain in a Patient Suffering from Complex Regional Pain Syndrome: A Case Report</p>

Abstract

Purpose: Complex regional pain syndrome (CRPS) is a rare neuropathic pain condition characterized by sensory, motor and autonomic alterations. Previous investigations have shown that transcranial direct current stimulation (tDCS) and transcutaneous electrical nerve stimulation (TENS) can alleviate pain in various populations, and that a combination of these treatments could provide greater hypoalgesic effects. In the present case report, we describe the effect of tDCS and TENS treatment on pain intensity and unpleasantness in a patient suffering from chronic CRPS. Results: The patient was a 37-year-old woman, suffering from left lower limb CRPS (type I) for more than 5 years. Despite medication (pregabalin, tapentadol, duloxetine), rehabilitation treatments (sensorimotor retraining, graded motor imagery) and spinal cord stimulation (SCS), the participant reported moderate to severe pain. Treatments of tDCS alone (performed with SCS turned off during tDCS application, 1 session/day, for 5 consecutive days) did not significantly decrease pain. Combining tDCS with TENS (SCS temporarily turned off during tDCS, 1 session/day, for 5 consecutive days) slightly reduced pain intensity and unpleasantness. Discussion: Our results suggest that combining tDCS and TENS could be a therapeutic strategy worth investigating further to relieve pain in chronic CRPS patients. Future studies should examine the efficacy of combined tDCS and TENS treatments in CRPS patients, and other chronic pain conditions, with special attention to the cumulative and long-term effects and its effect on function and quality of life.

Theta-Burst Stimulation of Forearm Muscles in Patients With Complex Regional Pain Syndrome: Influence on Brain and Clinical Outcomes

“…Pain decrease in parallel with an increase in the worst finger PIP active ROM resembles the changes reported after 15-30 sessions of transcutaneous electrical neurostimulation (TENS) (71)(72)(73)(74) or after 5 sessions of TENS in combination with brain stimulation (75). Thus, the similarity with our results after only one session of rPMS suggest that rPMS in CRPS was likely more efficient than TENS in CRPS.…”

Analgesic Effect of Noninvasive Brain Stimulation for Neuropathic Pain Patients: A Systematic Review

“…As also outlined in Table 1, a total of six articles and 125 NP patients were involved in tDCS treatment. Among them, five studies Studies of rTMS treatment are labeled yellow, studies of tDCS treatment are labeled green, and studies of ineffective treatment are labeled gray rTMS repetitive transcranial magnetic stimulation, tDCS transcranial direct current stimulation, ACC anterior cingulate cortex, PSI posterior superior insula, M1 primary motor cortex, DLPFC dorsolateral prefrontal cortex, PMC premotor cortex, S1 primary somatosensory cortex, S2 secondary somatosensory cortex involving 95 NP patients (76.0%) also showed that tDCS successfully relieved NP [39,40,43,44]. Thirty NP patients (24.0%) did not experience pain relief, as reported by Jensen MP et al [41].…”

“…Other conditions, such as complex regional pain syndrome (CRPS) [44], fibromyalgia, or polyneuropathy [41], can also cause NP. Among NIBS-treated patients with TNP induced by other sources (n = 14) (Fig.…”

Case Report: Initial Evidence of Safety and Efficacy of High Definition-Transcranial Direct Current Stimulation in a Patient With Neuropathic Pain and Implanted Spinal Cord Stimulator

“…Similarly, less favorable efficacy of primary motor rTMS has been observed in lower limb neuropathic pain relative to face or upper limb neuropathic pain for (42,43). It should be noted that Houde et al (15) did not include a TENS only condition and that the time interval between tDCS and TENS may have been too short to differentiate the analgesic effect of tDCS alone from the potential synergetic effect of both interventions. Furthermore, tDCS was not used as a biomarker in the setting of patient selection for chronic epidural MCS.…”