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Park HS, Kim JH. Effect of transcranial direct current stimulation on supernumerary phantom limb pain in spinal cord injured patient: A case report. World J Clin Cases 2024; 12:3177-3182. [PMID: 38898872 PMCID: PMC11185370 DOI: 10.12998/wjcc.v12.i17.3177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/13/2024] [Accepted: 04/25/2024] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND Supernumerary phantom limb (SPL) sensation is the experience of additional limbs, either single or a pair of limbs. Unique to traumatic spinal cord injuries, we report effect of transcranial direct current stimulation (tDCS) on SPL pain in a patient with cervical cord injury. CASE SUMMARY The subject was a 57-year-old man who was diagnosed with complete spinal cord injury (C6/C5, motor level; C5/C5, sensory level; AIS-A) approximately three months ago. After a period of 2 wk, we administered anodal tDCS over the motor cortex for 15 minutes at an intensity of 1.5 mA. Following that treatment, the patient experienced a decrease of SPL pain intensity and frequency, which lasted for 1 week after the end of treatment. CONCLUSION Targeting the motor cortex through neuromodulation appears to be a promising option for the management of SPL pain.
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Affiliation(s)
- Hyo-Sik Park
- Department of Interventional Physiatry, Eulji University Medical Center, Seo-Gu, Daejeon, South Korea
| | - Jae-Hyung Kim
- Department of Interventional Physiatry, Eulji University Medical Center, Seo-Gu, Daejeon, South Korea
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Doshi TL, Dworkin RH, Polomano RC, Carr DB, Edwards RR, Finnerup NB, Freeman RL, Paice JA, Weisman SJ, Raja SN. AAAPT Diagnostic Criteria for Acute Neuropathic Pain. PAIN MEDICINE 2021; 22:616-636. [PMID: 33575803 DOI: 10.1093/pm/pnaa407] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Acute neuropathic pain is a significant diagnostic challenge, and it is closely related to our understanding of both acute pain and neuropathic pain. Diagnostic criteria for acute neuropathic pain should reflect our mechanistic understanding and provide a framework for research on and treatment of these complex pain conditions. METHODS The Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION) public-private partnership with the U.S. Food and Drug Administration (FDA), the American Pain Society (APS), and the American Academy of Pain Medicine (AAPM) collaborated to develop the ACTTION-APS-AAPM Pain Taxonomy (AAAPT) for acute pain. A working group of experts in research and clinical management of neuropathic pain was convened. Group members used literature review and expert opinion to develop diagnostic criteria for acute neuropathic pain, as well as three specific examples of acute neuropathic pain conditions, using the five dimensions of the AAAPT classification of acute pain. RESULTS AAAPT diagnostic criteria for acute neuropathic pain are presented. Application of these criteria to three specific conditions (pain related to herpes zoster, chemotherapy, and limb amputation) illustrates the spectrum of acute neuropathic pain and highlights unique features of each condition. CONCLUSIONS The proposed AAAPT diagnostic criteria for acute neuropathic pain can be applied to various acute neuropathic pain conditions. Both the general and condition-specific criteria may guide future research, assessment, and management of acute neuropathic pain.
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Affiliation(s)
- Tina L Doshi
- Department of Anesthesiology and Critical Care Medicine, Division of Pain Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Robert H Dworkin
- Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, New York, and Department of Neurology, Center for Human Experimental Therapeutics, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Rosemary C Polomano
- Division of Biobehavioral Health Sciences, University of Pennsylvania-School of Nursing, Philadelphia, Pennsylvania, USA
| | - Daniel B Carr
- Public Health and Community Medicine Program, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Nanna B Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, and Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Roy L Freeman
- Center for Autonomic and Peripheral Nerve Disorders, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Judith A Paice
- Cancer Pain Program, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Steven J Weisman
- Jane B. Pettit Pain and Headache Center, Children's Wisconsin, Departments of Anesthesiology and Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Srinivasa N Raja
- Department of Anesthesiology and Critical Care Medicine, Division of Pain Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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Diaz-Segarra N, McKay O, Kirshblum S, Yonclas P. Management of nonpainful supernumerary phantom limbs after incomplete spinal cord injury with visual-tactile feedback therapy: a case report. Spinal Cord Ser Cases 2020; 6:62. [PMID: 32647132 DOI: 10.1038/s41394-020-0312-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Supernumerary phantom limb (SPL) is an uncommon phantom sensation where the patient experiences the illusory presence of one or more limbs in addition to their existing limbs. SPL after a spinal cord injury (SCI) is rare with few documented cases. There is minimal treatment guidance available, with some reports of visual-tactile feedback therapy used to manage SPL. CASE PRESENTATION A 43-year-old male sustained a C4 ASIA Impairment Scale grade C SCI, developing the sensation of two SPL arms originating from his shoulders 6 days after injury. He developed a self-directed method of visual-tactile feedback as a means to improve the SPL sensations, consisting of shrugging his shoulders repeatedly for 1 min while observing the movement of his actual arms. After completion of this routine, the SPL moved to the same location as his arms, providing relief. Also, an elastic band was placed on a sensate region of his arm, providing additional visual-tactile feedback. The SPL improved and resolved by day 45. DISCUSSION SPL after SCI is poorly characterized, usually occurring within 6-7 days of injury after a complete or incomplete cervical SCI. While the mechanism is unclear, the inability to integrate visual, tactile, and proprioceptive information after deafferentation may contribute to development. Similarities between SPL and phantom limb sensation after an amputation have resulted in the use of visual and visual-tactile feedback therapy for painful SPL management. This is the first case documenting successful use of visual-tactile feedback therapy to manage nonpainful SPL.
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Affiliation(s)
- Nicole Diaz-Segarra
- Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark, NJ, USA.
| | - Ondrea McKay
- Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Steven Kirshblum
- Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark, NJ, USA.,Kessler Institute for Rehabilitation, West Orange, NJ, USA
| | - Peter Yonclas
- Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark, NJ, USA.,Department of Surgery, Rutgers-New Jersey Medical School, Newark, NJ, USA
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Lu YS, Tong P, Guo TC, Ding XH, Zhang S, Zhang XJ. Effects of combined rTMS and visual feedback on the rehabilitation of supernumerary phantom limbs in a patient with spinal cord injury: A case report. World J Clin Cases 2019; 7:3120-3125. [PMID: 31624763 PMCID: PMC6795722 DOI: 10.12998/wjcc.v7.i19.3120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 08/24/2019] [Accepted: 09/11/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Supernumerary phantom limb (SPL) caused by spinal cord injury (SCI) has previously been reported in several studies. However, the mechanisms and management of SPL in SCI patients are still not fully understood. Herein, we report a rare case of SPL in a patient with incomplete SCI.
CASE SUMMARY A 46-year-old man complained of four hands 7 d after SCI. He was diagnosed with SPL complicated with actual limb neuropathic pain. Following a period of treatment with neurotrophic agents and Chinese traditional and analgesic medications, SPL symptoms and actual limb pain did not improve. However, his symptoms gradually lessened after combined treatment with high-frequency repetitive transcranial magnetic stimulation (rTMS), a promising neuromodulation technique, over the M1 cortex and visual feedback. After 7 wk of this treatment, SPL disappeared completely and actual limb pain was significantly relieved.
CONCLUSION Cerebral plasticity changes may be a mechanism underlying the occurrence of non-painful SPL in SCI patients, and high-frequency rTMS applied to the M1 cortex could be a promising treatment method for SPL.
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Affiliation(s)
- Yin-Shan Lu
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
- Department of Rehabilitation Medicine, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
| | - Pei Tong
- Department of Rehabilitation Medicine, Taikang Tongji (Wuhan) Hospital, Wuhan 430000, Hubei Province, China
| | - Tie-Cheng Guo
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Xin-Hua Ding
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Song Zhang
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Xiu-Juan Zhang
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
- Department of Rehabilitation Medicine, Chengdu Second People's Hospital, Chengdu 610011, Sichuan Province, China
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Kim HR, Han JY, Park YH, Kim BJ, Yang W, Kim S. Supernumerary phantom limb in a patient with basal ganglia hemorrhage - a case report and review of the literature. BMC Neurol 2017; 17:180. [PMID: 28886692 PMCID: PMC5591514 DOI: 10.1186/s12883-017-0962-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 09/04/2017] [Indexed: 11/13/2022] Open
Abstract
Background Supernumerary phantom limb (SPL) is a rare neurologic phenomenon, in which a patient misperceives an extra limb in addition to the original set of limbs. We report a case of SPL in a patient with a right basal ganglia hemorrhage and review the previous literature about this peculiar phenomenon. Case presentation Two days after the event of a right basal ganglia hemorrhage, a 78-year-old male reported a phantom arm protruding from his left shoulder. He could not see or touch the phantom arm but he felt the presence of an addition arm lateral to his paretic arm. Pain or sensory discomfort were absent in either the paretic arm or the phantom arm. He stated that he could intentionally move the phantom arm independent of his paretic arm. The examination showed that the passive movement of his paretic arm did not elicit any movement of his phantom arm. We diagnosed the SPL as a complication of the hypertensive basal ganglia hemorrhage and treated him with anti-hypertensive medications. His phantom arm persisted for 3 weeks, and it gradually faded away. Conclusion SPL had been reported as a rare complication of various types of cerebral lesions. Right hemispheric lesions were most frequently associated with the SPL. Considering the intentional movement of the phantom arm, we deduced that the SPL might result from the impairment of the sensory feedback system for both internal body image and motor movement.
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Affiliation(s)
- Hang-Rai Kim
- Clinical Neuroscience Center, Seoul National University Bundang Hospital, 82, Gumi-ro 173, Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Republic of Korea.,Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jee-Young Han
- Clinical Neuroscience Center, Seoul National University Bundang Hospital, 82, Gumi-ro 173, Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Republic of Korea.,Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young Ho Park
- Clinical Neuroscience Center, Seoul National University Bundang Hospital, 82, Gumi-ro 173, Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Republic of Korea.,Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Beom Joon Kim
- Clinical Neuroscience Center, Seoul National University Bundang Hospital, 82, Gumi-ro 173, Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Republic of Korea.,Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Wookjin Yang
- Clinical Neuroscience Center, Seoul National University Bundang Hospital, 82, Gumi-ro 173, Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Republic of Korea.,Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - SangYun Kim
- Clinical Neuroscience Center, Seoul National University Bundang Hospital, 82, Gumi-ro 173, Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Republic of Korea. .,Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Fusco G, Tidoni E, Barone N, Pilati C, Aglioti SM. Illusion of arm movement evoked by tendon vibration in patients with spinal cord injury. Restor Neurol Neurosci 2016; 34:815-26. [DOI: 10.3233/rnn-160660] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Gabriele Fusco
- Department of Psychology, University of Rome “Sapienza”, Rome, Italy
- IRCCS Fondazione Santa Lucia, IRCCS, Rome, Italy
| | - Emmanuele Tidoni
- Department of Psychology, University of Rome “Sapienza”, Rome, Italy
- IRCCS Fondazione Santa Lucia, IRCCS, Rome, Italy
| | - Nicola Barone
- Hospital A.Alesini C.T.O., Unipolar Unit, Rome, Italy
| | | | - Salvatore Maria Aglioti
- Department of Psychology, University of Rome “Sapienza”, Rome, Italy
- IRCCS Fondazione Santa Lucia, IRCCS, Rome, Italy
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Tidoni E, Tieri G, Aglioti SM. Re-establishing the disrupted sensorimotor loop in deafferented and deefferented people: The case of spinal cord injuries. Neuropsychologia 2015; 79:301-9. [PMID: 26115603 DOI: 10.1016/j.neuropsychologia.2015.06.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 06/15/2015] [Accepted: 06/21/2015] [Indexed: 11/26/2022]
Abstract
Acting efficiently in the world depends on the activity of motor and somatosensory systems, the integration of which is necessary for the proper functioning of the sensorimotor loop (SL). Profound alterations of SL functioning follow spinal cord injury (SCI), a condition that brings about a disconnection of the body from the brain. Such disconnection creates a substantial deprivation of somatosensorial inputs and motor outputs. Consequent somatic deficits and motor paralysis affect the body below the lesion level. A complete restoration of normal functions of the SL cannot be expected until basic neuroscience has found a way to re-establish the interrupted neural connectivity. Meanwhile, studies should focus on the development of technical solutions for dealing with the disruption of the sensorimotor loop. This review discusses the structural and functional adaptive reorganization of the brain after SCI, and the maladaptive mechanisms that impact on the processing of body related information, which alter motor imagery strategies and EEG signals. Studies that show how residual functions (e.g. face tactile sensitivity) may help people to restore a normal body image are also reviewed. Finally, data on how brain and residual body signals may be used to improve brain computer interface systems is discussed in relation to the issue of how such systems may help SCI people to re-enter the world and interact with objects and other individuals.
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Affiliation(s)
- E Tidoni
- Department of Psychology, University of Rome "La Sapienza", Rome, Italy; Fondazione Santa Lucia, IRCCS, Rome, Italy.
| | - G Tieri
- Fondazione Santa Lucia, IRCCS, Rome, Italy; Braintrends Ltd, Applied Neuroscience, Rome, Italy
| | - S M Aglioti
- Department of Psychology, University of Rome "La Sapienza", Rome, Italy; Fondazione Santa Lucia, IRCCS, Rome, Italy.
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Katayama O, Iki H, Sawa S, Osumi M, Morioka S. The effect of virtual visual feedback on supernumerary phantom limb pain in a patient with high cervical cord injury: a single-case design study. Neurocase 2015; 21:786-92. [PMID: 25676730 DOI: 10.1080/13554794.2015.1011664] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We characterized the effect of virtual visual feedback (VVF) on supernumerary phantom limb pain (SPLP) in a patient with high cervical cord injury. The subject was a 22-year-old man diagnosed with complete spinal cord injury (level C2) approximately 5 years ago. We applied the ABA'B' single-case design and set phases B and B' as intervention phases for comparison. SPLP significantly improved in comparison of phase A with phase B and phase A with phase B'. We suggest that VVF reduces SPLP and the effect lasts after VVF.
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Affiliation(s)
- Osamu Katayama
- a Department of Neurorehabilitation, Graduate School of Health Sciences , Kio University , Nara , Japan
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