Gestural Interaction and Visual Illusion for Lower Limbs' Neuropathic Pain Treatment.

Pain caused by a lesion or a disease affecting the somatosensory nervous system is known as Neuropathic pain. It has been shown that neuropathic pain can be treated with the combination of simultaneous transcranial direct current stimulation and the generation of the visual illusion that the patient retains control of the affected limbs. For persons with neuropathic pain in the lower limbs, the visual illusion consists of an image of the patient walking normally. Such a visual illusion has classically been generated by using a physical mirror and a projector. The objective of this paper is to develop and validate a computer-based version of the visual illusion, including Gestural Control. The developed system has been validated in a trial and has been successfully implanted in daily clinical practice in a reference neurorehabilitation hospital. A retrospective statistical analysis shows that the patients treated with the computer-based system reduce their pain level significantly more than the patients treated with the mirror and projector treatment before the introduction of the computer-based version. Furthermore, it also makes possible to bring the therapy to the home of the patients, where the treatment can be self-administered while still being monitored by the clinical staff.

Sensory Symptom Profiles of Patients With Neuropathic Pain After Spinal Cord Injury.

AIM: Individuals experiencing neuropathic pain (NP) after spinal cord injury (SCI) present with a variety of pain descriptors in different combinations and at different intensities. These sensory features form distinct patterns, known as sensory symptom profiles. METHODS: In the present cross-sectional study, we have used a multivariate statistical method (multiple correspondence analysis) to categorize the sensory symptom profiles of a cohort of 338 patients with at-level or below-level NP after SCI. We also investigated possible associations between positive neuropathic symptoms and features of the neurological lesion. RESULTS: The majority of participants had a combination of pain descriptors, with 59% presenting with 3 or 4 pain subtypes. No significant associations were found between specific pain profiles and etiology or clinical degree of the neurological lesion. Furthermore, similar symptom profiles were seen in patients with at-level and below-level NP. The most frequent pattern observed in patients with cervical SCI consisted predominantly of electric shocks and tingling, without burning, pressure pain, or allodynia. CONCLUSIONS: Classification of SCI-NP patients into the 5 groups identified in the present study based on their distinct sensory symptom profiles may allow identification of those most likely to respond to a specific analgesic approach.

Depression in Individuals With Traumatic and Nontraumatic Spinal Cord Injury Living in the Community.

OBJECTIVE: To assess depression in a sample of individuals with spinal cord injury (SCI) living in the community, and to determine the prevalence of probable major depressive disorder (PMDD) among those with traumatic spinal cord injury (T-SCI) and those with nontraumatic spinal cord injury (NT-SCI). DESIGN: Cross-sectional. SETTING: Data were collected on individuals with SCI now living in the community, who completed a comprehensive follow-up assessment at the hospital. PARTICIPANTS: Individuals with T-SCI or NT-SCI (N=831) completed the Patient Health Questionnaire-9 (PHQ-9) and were included. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The PHQ-9 was used to detect the presence of PMDD and to measure the severity of the depression. RESULTS: The most frequent etiology of SCI was T-SCI (66.9%). Overall, 16.2% of participants met the criteria for PMDD; however, a higher prevalence was noted for individuals with NT-SCI (21.1%) than for individuals with T-SCI (13.8%). Risk factors between T-SCI and NT-SCI did not differ greatly. Female sex, chronic pain, and lower levels of/difficulties in participation were associated with the presence of PMDD. CONCLUSIONS: PMDD appears to occur at a higher rate in individuals with NT-SCI, with greater symptom severity. The finding that problems with participation are directly associated with depression raises the need for specific treatment goals, with the aim of empowering individuals with SCI to reintegrate into the community. Potential stress factors (eg, environmental barriers, limited participation options) should be addressed accordingly.