Have I Been Touched? Subjective and Objective Aspects of Tactile Awareness.

Somatosensory tactile experience is a key aspect of our interaction with the environment. It is involved in object manipulation, in the planning and control of actions and, in its affective components, in the relationships with other individuals. It is also a foundational component of body awareness. An intriguing aspect of sensory perception in general and tactile perception in particular is the way in which stimulation comes to consciousness. Indeed, although being aware of something seems a rather self-evident and monolithic aspect of our mental states, sensory awareness may be in fact modulated by many different processes that impact on the mere stimulation of the skin, including the way in which we perceive our bodies as belonging to us. In this review, we first took into consideration the pathological conditions of absence of phenomenal experience of touch, in the presence of implicit processing, as initial models for understanding the neural bases of conscious tactile experience. Subsequently, we discussed cases of tactile illusions both in normal subjects and in brain-damaged patients which help to understand which high-order processes impact tactile awareness. Finally, we discussed the observations reported in the review in light of some influential models of touch and body representation.

Upper-Extremity Nerve Transfers for Sensation: A Systematic Review.

PURPOSE: Sensory nerve transfers may be performed to restore protective sensation and tactile perception after peripheral nerve injury in the upper extremity. There is a paucity of literature on the available donor-recipient configurations for sensory nerve transfers. This article presents a systematic review of reported sensory nerve transfers in the upper extremity. METHODS: Original articles published between 1982 and 2022 were searched in MEDLINE and EMBASE. Articles describing a sensory nerve transfer were included if patient sensory outcomes were reported. Outcomes were categorized according to the modified British Medical Research Council scale, with an outcome of S3 or better defined as satisfactory. RESULTS: Of 1,049 articles, 39 met inclusion and quality criteria. Twenty-seven articles were primary research studies reporting on 197 patients who underwent 11 unique nondigital sensory donor nerve transfers and 24 unique digital donor nerve transfer procedures. The most reliable recipient nerve for restoring sensation to the ulnar border of the small finger was proper ulnar digital nerve of the small finger (38 patients, 89% satisfactory sensory outcome). The best available donors for transfer into the proper ulnar digital nerve of the small finger were proper ulnar digital nerve of the long finger (16 patients, 87.5% good sensory outcome) and palmar cutaneous branch of the median nerve (15 patients, 100% good sensory outcome). To restore sensation along the ulnar border of the thumb and radial aspect of the index finger, the best available donor was the superficial branch of the radial nerve, regardless of transfer into common digital nerve 1 (38 patients, success rate 63%) or directly to proper ulnar digital nerve of the thumb or proper radial digital nerve of the index finger (nine patients, success rates 67%). CONCLUSIONS: Outcomes after sensory nerve transfers are generally good. Surgeons should transfer into a digital nerve recipient when attempting to reconstruct sensation. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Relationship between Tilt Sensation Ability and Lower Limb Injuries in Junior Athletes.

The purpose of this study was to devise a tilt sensation measurement method to evaluate ankle proprioception and to examine its reliability. It was also used to determine the relationship among tilt sensation abilities, physical development, and lower limb injuries in junior athletes. In this study, a step platform created tilt angles. Participants with eye masks answered "yes" or "no" to sensing a tilt, evaluated over nine or seven trials. Experiment 1 involved 22 university students (20.6 ± 0.9 years). The minimum angle at which a tilt could be sensed while standing on both feet was determined, and measurements were taken again to examine reliability. Experiment 2 involved 40 junior athletes (12.3 ± 2.0 years), where the minimum angle for tilt sensation was obtained, and medical checks were conducted to assess injuries in the knee, lower leg, and foot. Reliability studies showed a moderately significant correlation between the first and second sessions (r = 0.504, p = 0.017), suggesting the reliability of the experimental method. The proportion capable of sensing a tilt of 1.1° and 1.6° was significantly higher in junior high school students than in elementary school students (1.1°; χ2 = 8.839, p = 0.003. 1.6°; χ2 = 4.038, p = 0.044). The group unable to sense a tilt of 1.6° and 2.1° had a significantly higher positive rate of knee injuries compared to the sensed group among junior high school students (1.6°; χ2 = 4.622, p = 0.032. 2.1°; χ2 = 4.622, p = 0.032). Our findings suggested that a reduced tilt sensation ability was associated with knee injuries in junior high school students. Utilizing our devised tilt sensation assessment could play a crucial role in preventing and detecting early injuries in junior high school students.

Validity of Computer-Controlled Skin Sensation Threshold Measurements and Relationship to Balance in Older People.

Falls are an important health issue for older people, as they lead to increased morbidity and mortality and reduced physical function, activities of daily living, and quality of life. Skin sensation is an indicator of the ability to maintain balance, which is a factor in fall risk. We investigated the validity of a computer-controlled plantar-foot sensation-testing instrument (PFS tester) that measures skin sensation. We examined the within-subject reproducibility of skin sensation thresholds and their relationship to balance in older participants. Within-subject skin sensation threshold reproducibility was examined using intraclass correlation coefficients. The skin sensation thresholds showed moderate within-subject reproducibility. The associations between skin sensation thresholds and balance were examined using multiple regression analysis. We found a significant relationship between skin sensation thresholds and balance. The results indicate that the PFS tester is clinically applicable and a reliable indicator of balance ability.

Does the Effect of Mental Fatigue Created by Motor Imagery on Upper Extremity Functions Change with Diaphragmatic Breathing Exercises? A Randomized, Controlled, Single-Blinded Trial.

Background and Objectives: This study focused on the impact of mental fatigue induced by motor imagery on upper limb function, an area with limited research compared to lower limb performance. It aimed to explore how diaphragmatic breathing exercises influence these effects. Materials and Methods: This study included 30 participants, and Group 1 participated in 12 sessions of diaphragmatic breathing exercises under the supervision of a physiotherapist; Group 2 did not receive any intervention. For all the participants, mental fatigue was induced with motor imagery before and after the intervention, and evaluations were performed before and after mental fatigue. Upper extremity functions were evaluated using isometric elbow flexion strength, hand grip strength, upper extremity reaction time and endurance, finger reaction time, the nine-hole peg test, shoulder position sense, light touch-pressure threshold, and two-point discrimination. Results: The study results showed that after mental fatigue, there was a decrease in isometric elbow flexion strength, nondominant hand grip strength, and nondominant upper extremity endurance, and an increase in nondominant tactile sensation (p < 0.05). No changes were found in two-point discrimination, nine-hole peg test time, and position sense on either side (p > 0.05). The effect of mental fatigue on isometric elbow flexion strength and nondominant grip strength showed significant improvement following diaphragmatic breathing exercises (p < 0.05). Conclusions: This study found that mental fatigue from motor imagery can impact elbow flexion, hand grip strength, upper extremity endurance, and tactile sensitivity. Breathing exercises may help improve strength parameters affected by mental fatigue. It is crucial to consider these effects on upper extremity functions in rehabilitation programs.

Nanofluidic Membrane-Assisted Organic Electrochemical Transistors for Bioinspired Gustatory Sensation Based on Selective Cation Transport.

Natural organisms have evolved precise sensing systems relying on unique ion channels, which can efficiently perceive various physical/chemical stimuli based on ionic signal transmission in biological fluid environments. However, it is still a huge challenge to achieve extensive applications of the artificial counterparts as an efficient wet sensing platform due to the fluidity of the working medium. Herein, nanofluidic membranes with selective cation transport properties and solid-state organic electrochemical transistors (OECTs) with amplified signals are integrated together to mimic human gustatory sensation, achieving ionic gustatory reagent recognition and a portable configuration. Cu-HHTP nanofluidic membranes with selective cation transport through their uniform micropores are constructed first, followed by assembly with OECTs to form the designed nanofluidic membrane-assisted OECTs (nanofluidic OECTs). As a result, they can distinguish typically ionic gustatory reagents, and even ionic liquids (ILs), demonstrating enhanced gustatory perception performance under a wide concentration range (10-7-10-1 m) compared with those of conventional OECTs. The linear correlations between the response and the reagent concentration further indicate the promising potential for practical application as a next-generation sensing platform. It is suggested that nanofluidic membranes mediated intramembrane cation transport based on the steric hindrance effect, resulting in distinguishable and improved response to multiple ions.

Etiological and clinical profiles of patients with dysphagia: A teaching institution experience.

Background: Dysphagia can involve any structure from the mouth to the lower esophageal sphincter. The etiologies vary from benign causes to malignant lesions. There is dearth of data regarding dysphagia in our population. Methods: A total of 208 patients with complaints of dysphagia were screened for the study. After ruling out neurological/local oropharyngeal causes of dysphagia, 200 patients with suspected esophageal dysphagia (ED) were recruited in the study. Dysphagia was graded as per the dysphagia scoring system. All patients underwent upper gastro-intestinal endoscopy and were evaluated for the presence of mechanical and non-mechanical causes of ED. Results: The mean age of patients with dysphagia was 53.8 ± 15.4 years. with males and females being 82 and 118, respectively. The mean duration of the symptom was 7.2 ± 10.6 months (median 3 months). Ninety-eight patients (49%) having dysphagia were in the age group of 56-65 years. The dysphagia score was 0 among 58, and 4 among 26 subjects. Foreign body sensation was the most frequent chief complaint in 90 (45%) patients. Ninety-six (48%) and 104 (52%) patients had mechanical and non-mechanical causes of dysphagia, respectively. Among mechanical causes of dysphagia, 68 patients (70.8%) had esophageal growth and 28 (29.2%) had esophageal stricture. Sixty-seven patients had squamous cell carcinoma. Among non-mechanical causes, 50 (48.1%) had globus sensation, 24 (23.1%) had hiatus hernia, and 16 (15.4%) functional dysphagia. Conclusion: Dysphagia is a common problem with varied etiologies. The esophageal growth and globus sensation are among the predominant causes of ED. We stress that all patients of dysphagia must be meticulously investigated.

Predicting tingling sensations induced by autonomous sensory meridian response (ASMR) videos based on sound texture statistics: a comparison to pleasant feelings.

Sound serves as a potent medium for emotional well-being, with phenomena like the autonomous sensory meridian response (ASMR) showing a unique capacity for inducing relaxation and alleviating stress. This study aimed to understand how tingling sensations (and, for comparison, pleasant feelings) that such videos induce relate to acoustic features, using a broader range of ASMR videos as stimuli. The sound texture statistics and their timing predictive of tingling and pleasantness were identified through L1-regularized linear regression. Tingling was well-predicted (r = 0.52), predominantly by the envelope of frequencies near 5 kHz in the 1500 to 750 ms period before the response: stronger tingling was associated with a lower amplitude around the 5 kHz frequency range. This finding was further validated using an independent set of ASMR sounds. The prediction of pleasantness was more challenging (r = 0.26), requiring a longer effective time window, threefold that for tingling. These results enhance our understanding of how specific acoustic elements can induce tingling sensations, and how these elements differ from those that induce pleasant feelings. Our findings have potential applications in optimizing ASMR stimuli to improve quality of life and alleviate stress and anxiety, thus expanding the scope of ASMR stimulus production beyond traditional methods. This article is part of the theme issue 'Sensing and feeling: an integrative approach to sensory processing and emotional experience'.

Efficacy of plantar tactile sensation and balance in patients with subacute stroke following plantar kinesio taping: a randomized, cross-over preliminary study.

BACKGROUND: Kinesio tape (KT) is known to enhance tactile sensation. In stroke rehabilitation, KT is often used alongside conventional therapy (CT) to improve balance recovery. OBJECTIVE: In this study, we aimed to evaluate the effectiveness of plantar KT in enhancing plantar tactile sensation (PTS) and balance ability in subacute stroke patients. METHODS: In this randomized crossover trial, 22 subacute stroke participants were randomly assigned to receive no taping, paretic plantar KT, or bilateral plantar KT, with a 24-h washout period between each condition. All participants underwent 30 min of CT. The primary outcome was PTS, involving tactile sensitivity in five areas on the plantar surface and the contact area with the ground of the paretic foot. The one-leg stand (OLS) time, functional reach test (FRT), and timed up-and-go test (TUG) were employed as secondary outcomes. RESULTS: Paretic plantar KT application led to significant increases in the contact area, OLS, FRT, and TUG test times. Particularly, bilateral plantar KT showed significantly greater improvement in PTS compared to paretic plantar KT. Additionally, bilateral plantar KT significantly improved OLS (p < 0.001, η2 = 0.575), FRT (p < 0.001, η2 = 781), and TUG (p < 0.001, η2 = 0.771) times compared with paretic plantar KT. CONCLUSIONS: This study demonstrated that plantar KT improved PTS and balance ability in stroke rehabilitation. The findings suggest that bilateral plantar KT as an adjunct to CT may have a beneficial effect on balance recovery in patients with subacute stroke. TRIAL REGISTRATION: Clinical trial KCT0009048.

[Fillet flap transfer as alternative to conventional lower limb amputation]. / Filetlappentransfer als Alternative zu konventionellen Amputationen der unteren Extremität.

BACKGROUND: The fitting of a prosthesis after lower limb amputation is associated with several challenges. Skeletal stump-prosthesis interfaces and selective nerve transfer can partially overcome these but are also associated with new impairments that emphasize the necessity of innovative approaches. The concept of so-called spare part surgery with the use of fillet flaps could play an important role in this respect. OBJECTIVE: An overview of the classical prosthesis-associated discomforts, advantages and disadvantages of treatment strategies and presentation of alternative surgical concepts. MATERIAL AND METHODS: A selective literature search was carried out considering the experiences of the authors and perspectives with respect to the advantages and disadvantages of the surgical treatment options. Furthermore, a clinical case is presented. RESULTS AND CONCLUSION: The transfer of the sole of the foot as a fillet flap to the weight-bearing region of the amputation stump offers a number of benefits, such as creating a fully weight-bearing stump, prevention of neuralgia, preserved sensation and conservation of the body image. As long as the calcaneal region is not impaired, this technique can be performed in amputations below as well as above the knee. The question of whether parts of the bone should be included in the transfer must be individually evaluated for each patient. This approach enables optimization of the residual limb stump for the subsequent fitting of a prosthesis for the patient.

Machine learning thermal comfort prediction models based on occupant demographic characteristics.

This study aims to investigate the predictive occupant demographic characteristics of thermal sensation (TS) and thermal satisfaction (TSa) as well as to find the most effective machine learning (ML) algorithms for predicting TS and TSa. To achieve this, a survey campaign was carried out in three mixed-mode buildings to develop TS and TSa prediction models by using six ML algorithms (Logistic Regression, Naïve Bayes, Decision Tree (DT), Random Forest (RF), K-Nearest Neighborhood (KNN) and Support Vector Machine). The prediction models were developed based on six demographic characteristics (gender, age, thermal history, education level, income, occupation). The results show that gender, age, and thermal history are significant predictors of both TS and TSa. Education level, income, and occupation were not significant predictors of TS, but were significant predictors of TSa. The study also found that RF and KNN are the most effective ML algorithms for predicting TS, while DT and RF are the most effective ML algorithms for predicting TSa. The study found that the accuracy of TS prediction models ranges from 83% to 99%, with neutral being the most correctly classified scale. The accuracy of TSa prediction models ranges from 84% to 97%, with dissatisfaction being the most common misclassification.

Vests with Radiative Cooling Materials to Improve Thermal Comfort of Outdoor Workers: An Experimental Study.

This study focuses on improving human thermal comfort in a high-temperature outdoor environment using vests with a radiative cooling coating. The effects of coating thickness on the radiative cooling performance were first evaluated, and an optimal thickness of 160 µm was achieved. Then, six subjects were recruited to evaluate the thermal comfort in two scenarios: wearing the vest with radiative cooling coatings, and wearing the standard vest. Compared with the standard vest, the coated vest decreases the maximum temperature at the vest inner surface and the outer surface by 5.54 °C and 4.37 °C, respectively. The results show that thermal comfort is improved by wearing radiative cooling vests. With an increase of wet bulb globe temperature (WBGT), the improving effects tend to decline. A significant improvement in human thermal comfort is observed at a WBGT of 26 °C. Specifically, the percentage of thermal sensation vote (TSV) wearing the cooling vest in the range of 0 to 1 increases from 29.2% to 66.7% compared with that of the untreated vest. At the same time, the average value of thermal comfort vote (TCV) increases from -0.5 to 0.2.

The functional role of conscious sensation of movement.

This paper proposes a new framework for investigating neural signals sufficient for a conscious sensation of movement and their role in motor control. We focus on signals sufficient for proprioceptive awareness, particularly from muscle spindle activation and from primary motor cortex (M1). Our review of muscle vibration studies reveals that afferent signals alone can induce conscious sensations of movement. Similarly, studies employing peripheral nerve blocks suggest that efferent signals from M1 are sufficient for sensations of movement. On this basis, we show that competing theories of motor control assign different roles to sensation of movement. According to motor command theories, sensation of movement corresponds to an estimation of the current state based on afferent signals, efferent signals, and predictions. In contrast, within active inference architectures, sensations correspond to proprioceptive predictions driven by efferent signals from M1. The focus on sensation of movement provides a way to critically compare and evaluate the two theories. Our analysis offers new insights into the functional roles of movement sensations in motor control and consciousness.

Correlations of Postural Stability to Proprioception, Tactile Sensation, and Strength Among People With Chronic Ankle Instability.

OBJECTIVES: The static and dynamic correlations of postural stability to its three potential contributors, namely, proprioception, tactile sensation, and strength remain unclear among people with chronic ankle instability (CAI). This study aimed to compare static and dynamic postural stability, along with proprioception, tactile sensation, and strength between people with and without CAI and explore their correlations. METHODS: Sixty-seven participants with CAI and 67 participants without CAI were enrolled in this study. Ankle proprioception, plantar tactile sensation, and lower limb strength were measured by a proprioception test device, a set of monofilaments, and a strength testing system, respectively. Static and dynamic postural stability were measured during standing and jump landing on a force plate and indicated by the root mean square of center of pressure and time to stability. RESULTS: Compared to people without CAI, people with CAI had poorer postural stability, proprioception, tactile sensation, and strength. Both groups demonstrated correlation between proprioception and static postural stability, but only people without CAI showed correlation between proprioception and dynamic postural stability. Both groups demonstrated a correlation between tactile sensation and static postural stability, but not with dynamic stability. Both groups demonstrated a correlation between strength and both static and dynamic postural stability. CONCLUSIONS: People with CAI had deficits in static and dynamic postural stability, proprioception, tactile sensation, and strength. Among people with CAI, proprioception, tactile sensation, and strength can help maintain static postural stability; strength can help maintain dynamic postural stability, whereas proprioception may not provide sufficient information for dynamic postural stability.

The Long-Term Loss of Smell and Taste in COVID-19 Patients ­ A Systematic Review and Meta-Analysis

Introduction: Olfactory symptoms have been reported as particular in COVID-19 patients. Objective: To synthesize and analyze the existing evidence on the monitoring loss of sense of smell and taste in COVID-19 patients, and for how long symptoms persist after the virus is no longer active in the organism. Methods: A search was implemented in PubMed, Embase, Scopus, Science Direct, and Web of Science databases. This systematic review and meta-analysis were conducted according to PRISMA, and the risk of bias was assessed through the Newcastle-Ottawa Scale. The review protocol is registered in PROSPERO. Results: Our systematic review included data from 14 articles with a total of 2143 participants. The most reported sensory symptom of COVID-19 was anosmia, which was detected in 1499 patients, being the only symptom to appear in all studies. Ageusia was detected in 595 patients, dysgeusia in 514 patients, and hyposmia in 209 patients. The studies provided the number of 729 patients with sensory symptoms during the acute COVID-19 infection of 15 days, and 1020 patients with lasting sensory symptoms, presenting sensory dysfunctions after the average latent period of 15 days of the acute COVID-19 infection. Conclusion: Evidence points to the loss or dysfunction of taste and smell as one of the symptoms of COVID-19 persisting for an average time of 15 days, with 44% of COVID-19 patients with persistent symptoms for more than 15 days. Nevertheless, most studies do not perform a follow-up with those patients. Therefore, further research on sensory symptoms and their follow-up is required.

Quantitative sensory testing in notalgia paresthetica reveals small fiber-type-specific differences in non-pruritic sensitivity: a pilot study.

Introduction: Notalgia paresthetica (NP) is a chronic condition characterized by pruritus and other unpleasant dysesthetic sensations unilaterally on the subscapular back. Its specific underlying mechanisms are largely unknown, though hypothesized to be neuropathic. Determination of possible somatosensory contributors to the condition could pave the way for novel treatments. Objectives: Given the potential involvement of non-pruritic mechanisms in NP, our objective was to broadly characterize the somatosensory function in NP-affected and unaffected skin using methods that have been standardized in pain-free controls and painful neuropathic disorders. We hypothesized that if NP is caused by neuropathic mechanisms not targeted directly to pruritoceptors in the skin, somatosensory abnormalities would not be itchspecific. Second, given the lack of symptoms on the contralateral side of the back, we hypothesized that this region would be normally sensitive. Methods: In this study, quantitative sensory testing (QST) was used to comprehensively assess the somatosensory function in 15 adult patients with NP. Standardized QST metrics were performed in the NP-affected region and compared with the contralateral asymptomatic skin and itch-free individuals using an age, gender, and site-matched reference data set. Results: There were no significant differences in sensitivity between symptomatic and asymptomatic skin, except for increased mechanical-evoked itch on the itchy side. However, reference data set comparisons revealed bilateral hyposensitivity to innocuous cold and noxious pinprick and higher temporal summation of pain in patients with NP. In addition, compared with reference data, patients with NP demonstrated decreased sensitivity to cold and pinprick, presence of paradoxical heat sensations, and increased wind-up of pain. Conclusion: These results suggest a role for Aδ fiber pathways and central sensitization in NP-associated itch. More research is needed to determine whether sensory differences extend beyond the NP-affected dermatomal level and what might cause neuropathy specifically targeting Aδ fibers.

The fear-avoidance model as an embodied prediction of threat.

The fear-avoidance model is a well-established framework in the understanding of persistent pain. It proposes a dichotomous path: either the context is interpreted as safe; there is no fear reaction and, therefore, the individual engages in active (positive) coping; or the context is interpreted as threatening, leading to a self-reinforcing vicious circle of fear and (negative) avoidance. We propose an embodied interpretation of this phenomenon employing the joint framework of predictive coding and active inference. The key idea is that multisensory integration of exteroceptive, proprioceptive, and interoceptive sensory inputs can lead to dysfunctional experiences of threat in nonthreatening situations. Threat inference can promote fear responses, maladaptive strategies (i.e., avoidance) and self-provides evidence for threat in associated or future contexts, or both. Under this treatment, the prediction of nonrealized threat becomes self-evidencing and context-invariant, and hence self-perpetuating. Safety cues are unable to attenuate the interpretation of the negative context as the dominant inference of the context is threatful and gains more precision and becomes resistant over time. Our model provides an explanation for the emergence of a dysfunctional fear response in the clinical setting despite apparent safety based on modern concepts from theoretical (computational) neuroscience.

Examination of Rumination's Mediating Role in the Relation Between Distal Personality Predictors, Cannabis Coping Motives, and Negative Cannabis-Related Consequences.

Objective: Perseverative cognitive processes, such as rumination, may indirectly influence effects of personality traits on cannabis use and related problems. Understanding relations among personality, rumination, and cannabis use motives may lead to better understanding of problematic cannabis use. The present study examined personality traits' influence on negative cannabis-related consequences via rumination and cannabis use coping motives. Methods: We tested a sequential path model across two independent samples such that the model was tested in one sample and replicated in the second sample. Participants were U.S. undergraduate students from multiple universities who reported using cannabis at least once in the prior thirty days. Results: Results partially supported hypotheses such negative urgency and distress tolerance were indirectly related to negative cannabis-related consequences via rumination and coping motives. Specifically, higher negative urgency and lower distress tolerance were related to higher rumination. Higher rumination was related to higher coping motives; which in turn was related to more negative cannabis-related consequences. Results indicate that rumination is a risk factor belying associations between personality and cannabis use to cope and negative consequences of use. Conclusions: Implementing techniques that attenuate rumination for individuals high in negative urgency or low in distress tolerance may reduce or prevent problematic cannabis and unintended outcomes.

Case Report: Recalcitrant oral lichen planus involving bilaterally buccal mucosae treated with a combination of photodynamic and photobiomodulation therapies.

Background: Managing recalcitrant oral lichen planus (OLP) can be challenging. Laser therapy has been suggested as an alternative to corticosteroids for treatment. Photodynamic therapy (PDT) is a non-invasive technique that enables the removal of lesions without surgery. Photobiomodulation therapy (PBMT) can promote healing and recovery of the lesions. Case presentation: The objective was to treat unresponsive bilateral OLP of the whole buccal mucosae with a combination of PDT and PBMT. Results: A 43-year-old Thai male presented with the severe painful reticular type of OLP of bilateral buccal mucosae involving upper and lower vestibular areas. The lesions were not remitted with either prednisolone systemic steroids or fluocinolone topical corticosteroids. After undergoing ten sessions of PDT with 10% 5-Aminolevulinic acid (5-ALA) in the form of thermoplastic gel and a 635 nm diode laser at 100 to 400 mW with an energy density of 20 to 30 J/cm 2 in continuous wave mode, combined with five interim-sessions of PBMT using a 635 nm diode laser at 200 to 300 mW with an energy density of 6 to 10 J/cm 2 in continuous wave, the patient reported relief of burning sensation beside remission of lesions without any complications. Conclusion: The wide-spreading recalcitrant OLP with burning sensation can be managed by combining PDT and PBMT.