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Long-term physical therapy for neuropathic pain after cervical spinal cord injury and resting state electroencephalography: a case report

Abstract

Introduction

Neuropathic pain after spinal cord injury is difficult to treat, and it is associated with abnormalities in the function of the thalamus-to-cortex neural circuitry. Aerobic exercise provides immediate improvement in neuropathic pain and is associated with abnormal resting electroencephalography (EEG) findings in patients with spinal cord injury. This study aimed to investigate whether physical therapy, including walking, can improve neuropathic pain and EEG peak alpha frequency (PAF) in the long term in a patient with cervical spinal cord injury.

Case presentation

A 50-year-old man was admitted with a cervical spinal cord insufficiency injury sustained one week prior. The residual height was C5. Neuropathic pain was observed in the fingers bilaterally. A numerical rating scale (NRS) was evaluated to measure the weekly mean and maximum intensities of pain. Resting EEG was measured, and the PAF was calculated. Each time point was evaluated in 2-week intervals from the time of admission, and the rate of change (Δ) of PAF was calculated based on the initial evaluation. Interventions included 18 weeks of standard physical therapy focusing on gait, with additional intensive gait training (4–10 weeks). The NRS scores for the mean and maximum intensities of pain decreased significantly after 6 weeks, and ΔPAF increased significantly after 4 weeks. Improvement in PAF coincided with the start of intensive gait training.

Discussion

PAF shifts to a high frequency during intensive gait training, suggesting the effectiveness of aerobic exercise. Furthermore, there is a close relationship between PAF, pain, and the quantification of pain changes.

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Fig. 1: The changes in each evaluation over time.

Data availability

Original data have been stored by the corresponding author and will be made available on request.

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Acknowledgements

We would like to thank Editage (www.editage.com) for English language editing.

Funding

This work was supported by a JSPS KAKENHI Grant-in-Aid for Young Scientists (Number 21K17482).

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GS carried out planning the work and participated in acquired the data and draft the manuscript. MO participated in the data analysis and helped to draft the manuscript. RM participated in acquire the data. SM participated in helping draft the manuscript. All authors approved the final manuscript.

Corresponding author

Correspondence to Gosuke Sato.

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The authors declare no competing interests.

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Written informed consent was obtained from the patient for the publication.

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Sato, G., Osumi, M., Mikami, R. et al. Long-term physical therapy for neuropathic pain after cervical spinal cord injury and resting state electroencephalography: a case report. Spinal Cord Ser Cases 8, 41 (2022). https://doi.org/10.1038/s41394-022-00510-0

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