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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

Authors Houde F, Harvey MP, Tremblay Labrecque PF, Lamarche F, Lefebvre A, Leonard G

Received 10 August 2019

Accepted for publication 24 December 2019

Published 2 March 2020 Volume 2020:13 Pages 467—473

DOI https://doi.org/10.2147/JPR.S226616

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Michael A Überall


Francis Houde, 1– 3 Marie-Philippe Harvey, 1, 3 Pierre-François Tremblay Labrecque, 1, 3 Francis Lamarche, 1, 3 Alexandra Lefebvre, 1, 3 Guillaume Leonard  1, 3

1Research Center on Aging, CIUSSS de l’Estrie - CHUS, Université de Sherbrooke, Sherbrooke, Québec, Canada; 2Research Center of the Centre hospitalier universitaire de Sherbrooke (CHUS), CIUSSS de l’Estrie – CHUS, Université de Sherbrooke, Sherbrooke, Québec, Canada; 3Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Québec, Canada

Correspondence: Guillaume Leonard
Centre de recherche sur le vieillissement, CIUSSS de l’Estrie - CHUS, 1036, rue Belvédère Sud, Sherbrooke, Québec J1H 4C4, Canada
Tel +1 (819) 829-7131 ext. 45246
Fax +1 (819) 820-6864
Email guillaume.leonard2@usherbrooke.ca

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.

Keywords: chronic pain, neuropathic pain, electrotherapy, peripheral electrical stimulation, peripheral nerve stimulation, non-invasive brain stimulation

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