Breathing-controlled electrical stimulation could modify the affective component of neuropathic pain after amputation: a case report

Abstract

In this case, a 31-year-old male suffered phantom neuropathic pain for more than 3 years after an above-the-knee amputation. His shooting phantom pain disappeared after the first session of breathing-controlled electrical stimulation, and reappeared or was triggered 28 days after an experimental error during which he received sustained electrical stimulation. In other words, painful shooting stimuli may not have been “cured” but forgotten and retriggered by a fearful event due to the experimental error. Therefore, this accidental finding provides a unique opportunity to understand sensory and affective components of neuropathic pain, and a novel intervention could modify the affective component of it.

Breathing-controlled Electrical Stimulation (BreEStim) for Management of Neuropathic Pain and Spasticity

“…Breathing-controlled electrical stimulation (BreEStim), as shown in the above two cases, has demonstrated clinical efficacy in spasticity management and subsequent hand function recovery in chronic stroke patients 16 , as well as management of neuropathic pain of central origin in the above patient with a spinal cord injury or of peripheral origin in a patient with above-the-knee amputation 17 . This enhanced clinical outcome and broader clinical applications of BreEStim are attributed to its unique approach.…”

“…BreEStim encourages active engagement of patients since voluntary breathing is required 17 . Patients feel they actively participate in managing their pain, rather than "a passive participant in their own care".…”

“…Patients feel they actively participate in managing their pain, rather than "a passive participant in their own care". For example, the patient controls the intensity of electrical stimulation, starting from zero to the highest level that the patient could tolerate 17 . This may enhance their treatment compliance.…”

“…When electrical stimulation is delivered to the finger extensors during the inspiratory phase of voluntary breathing, a long-lasting effect of reduction in finger flexor spasticity (muscle tone) in chronic stroke patient is observed 16 . In another study 17 , shooting phantom pain in a patient with an above-the-knee amputation disappeared after the BreEStim treatment, but re-appeared 28 days later after receiving a sustained electrical stimulation accidentally. This case study provides a unique opportunity to understand that the affective component of noxious stimuli of neuropathic pain (shooting phantom pain) has been modified by the BreEStim treatment, but then retriggered by an accidental stimulation.…”

“…Electromyogram (EMG)-triggered neuromuscular stimulation has been used to augment effectiveness of electrical stimulation in motor recovery [5][6][7][8][9][10][11][12][13][14] and spasticity reduction after stroke 7,15 . In this paper, a new EStim protocol -Breathing-controlled electrical stimulation (BreEStim), is introduced, according to recent research findings on the systemic effect of voluntary breathing 16,17 .…”