Junker-Tschopp C1,2, Böttger K3, Ljutow A3
1HES-SO, HETS - Psychomotricity, Geneva, Switzerland, 2CERPA (Centre de Réhabilitation Spécialisé pour Personnes Amputées / Rehabilitation Center for Phantom Pain), Mirebalais - Port-au-Prince, Haiti, 3Schweizer Paraplegiker-Zentrum, Schmerzen Clinic, Nottwil, Switzerland
Background: Neuropathic pain (NP) is a real challenging issue in medicine. Resulting from a nerve injury affecting the somatosensory system, NP is refractory to currently available treatments (analgesic, antiepileptic, antidepressant, surgical ectomy, spinal cord or cerebral stimulation). Besides its costs, medication is a constant burden in a lot of cases due to side effects or resistance to drugs. On the other hand, surgery provides only partial relief or create new pain problems.
Purpose: Neurosciences' discoveries bring out body-schema into the focus by providing a fundamental new understanding of NP phenomenon based on neural plasticity in the cortical areas integrating body-schema. In amputees, studies have shown a correlation between NP intensity and body-schema changes in the somatosensory cortex. Treatments focusing on body-schema reorganization might thus positively influence NP. This report describes one case of NP partial recovery after a neuro-psychomotor treatment.
Methods: The patient, aged 44, is suffering since 2014 from a right traumatic extended upper brachial plexus injury with, in C5-7, complete loss of motor function and sensory deficits. In 2016, first peripheral nerve reconstruction then spinal cord stimulation first helped reducing pain but did not show consistent improvement.
The neuro-psychomotor therapy consisted of 25 sessions lasting 1.5 hour spread out over 3 months. Treatment's length was settled according to the mean time needed for amputees' phantom pain to decrease and ultimately vanish.
The neuro-psychomotor treatment focused specifically on sensory-stimulation and body-schema reconstruction. The goal of the treatment was to reduce body-schema conflicts due to the lack of information in the injured body part.
NP and body-schema changes were assessed through a pre-test/post-test paradigm using
1) Saint-Antoine Pain Questionnaire,
2) CPGS Chronic Pain Grading Scale,
3) global psychomotor evaluation.
Results: At the time of the therapy, the patient's right arm was mostly paralyzed. He described persistent NP of 6-7/10 with paroxysmal peaches reaching 9.
Results were two folded. First, since the 4th session, pain was observed to drop dramatically to 1 or even 0 within each session. The patient compared the effect to the one produced with anesthetic drugs injection. Yet, pain went progressively back to its regular level 2-4 hours later. Second, body-schema exercises allowed a radical change in the movement: the right hand totally lost its spasticity, movements becoming smoother, adjusted in speed and accurate in space. Again, improvement vanished after a couple of hours.
Conclusion(s): The dramatic improvement observed within each neuro-psychomotor session tend to indicate that exercises focused on body-schema reorganization may contribute to some extent to motor and pain recovery. Unfortunately, the effect didn't last over time.
We may hypothesis that if the brain was clearly reacting to the treatment by taking the sensory information given, thus allowing to momentary alleviate pain, the learning process could not be settled as shown by no long term improvement. The question remains if a 3-months therapy wasn't too short.
Implications: Our findings support the notion that NP may be to some extent alleviated by methods recreating a complete, coherent body-schema. In this sense, neuro-psychomotricity may offer a novel non-pharmacological gateway to NP treatment.
Keywords: neuropathic pain, body schema, neuro-psychomotricity
Funding acknowledgements: Supported by the Swiss partners: SSI-Geneva, HES-SO, HETS-Geneva, Swiss Psychomotricity
Purpose: Neurosciences' discoveries bring out body-schema into the focus by providing a fundamental new understanding of NP phenomenon based on neural plasticity in the cortical areas integrating body-schema. In amputees, studies have shown a correlation between NP intensity and body-schema changes in the somatosensory cortex. Treatments focusing on body-schema reorganization might thus positively influence NP. This report describes one case of NP partial recovery after a neuro-psychomotor treatment.
Methods: The patient, aged 44, is suffering since 2014 from a right traumatic extended upper brachial plexus injury with, in C5-7, complete loss of motor function and sensory deficits. In 2016, first peripheral nerve reconstruction then spinal cord stimulation first helped reducing pain but did not show consistent improvement.
The neuro-psychomotor therapy consisted of 25 sessions lasting 1.5 hour spread out over 3 months. Treatment's length was settled according to the mean time needed for amputees' phantom pain to decrease and ultimately vanish.
The neuro-psychomotor treatment focused specifically on sensory-stimulation and body-schema reconstruction. The goal of the treatment was to reduce body-schema conflicts due to the lack of information in the injured body part.
NP and body-schema changes were assessed through a pre-test/post-test paradigm using
1) Saint-Antoine Pain Questionnaire,
2) CPGS Chronic Pain Grading Scale,
3) global psychomotor evaluation.
Results: At the time of the therapy, the patient's right arm was mostly paralyzed. He described persistent NP of 6-7/10 with paroxysmal peaches reaching 9.
Results were two folded. First, since the 4th session, pain was observed to drop dramatically to 1 or even 0 within each session. The patient compared the effect to the one produced with anesthetic drugs injection. Yet, pain went progressively back to its regular level 2-4 hours later. Second, body-schema exercises allowed a radical change in the movement: the right hand totally lost its spasticity, movements becoming smoother, adjusted in speed and accurate in space. Again, improvement vanished after a couple of hours.
Conclusion(s): The dramatic improvement observed within each neuro-psychomotor session tend to indicate that exercises focused on body-schema reorganization may contribute to some extent to motor and pain recovery. Unfortunately, the effect didn't last over time.
We may hypothesis that if the brain was clearly reacting to the treatment by taking the sensory information given, thus allowing to momentary alleviate pain, the learning process could not be settled as shown by no long term improvement. The question remains if a 3-months therapy wasn't too short.
Implications: Our findings support the notion that NP may be to some extent alleviated by methods recreating a complete, coherent body-schema. In this sense, neuro-psychomotricity may offer a novel non-pharmacological gateway to NP treatment.
Keywords: neuropathic pain, body schema, neuro-psychomotricity
Funding acknowledgements: Supported by the Swiss partners: SSI-Geneva, HES-SO, HETS-Geneva, Swiss Psychomotricity
Topic: Pain & pain management; Disability & rehabilitation
Ethics approval required: No
Institution: Schweizer Paraplegiker-Zentrum
Ethics committee: Schweizer Paraplegiker-Zentrum
Reason not required: It was not a scientific trial, just a therapeutical attempt giving support to a case report. That needs no ethical approval
All authors, affiliations and abstracts have been published as submitted.
