The goal of this feasibility study is to assess the feasibility of the combined treatment intervention "virtual walking (VW) and transcranial direct current stimulation (tDCS)" of neuropathic pain in patients with spinal cord injury. The main question aims to answer: • To assess the feasibility of combining VW and tDCS for longer-term use from the patients' point of view. Participants will: Receive a two week intervention in the Swiss Paraplegic Centre in Nottwil, where the participants undergo VW and tDCS for ten sessions, each lasting around 20 minutes. The participants keep a diary and a pain drawing of their symptoms and will fill out some questionnaires about their impression of feasibility, the pain intensity, chronicity, the impression of change, depression, anxiety, stress and adverse events. At the beginning and end of the study the participants will be interviewed about their expectations, hopes and the feasibility of the procedures from a participants point of view.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
OTHER
Masking
NONE
Enrollment
4
Participants will receive VW-therapy combined with tDCS. The intervention is adapted from Soler et al. 2010 and consists of 10 sessions over 2 weeks, each session lasting around 20 minutes. For the virtual walking the participant sits on a modified wheelchair, which is positioned at a distance of two meters from the screen. The setting provides an illusion of a third person perspective and the participant can see himself/herself walk through a forest ambience. The tDCS session is according the same protocol from Soler et al., 2010. Hereby, the device from Starstim, Neuroelectrics will be used, which is equipped with a neoprene cap containing electrodes. The anodes will be placed over C3 or C4 (EEG 10/20 system) to target the motor cortex (M1) contralateral to the painful side and the cathodes will be placed over the contralateral supraorbital area. Symmetric pain participants receive stimulation on the dominant hemisphere. The tDCS applies a constant current of 2 mA over 20 minutes.
Swiss Paraplegic Centre
Nottwil, Switzerland
Patient-reported expectations, acceptability and satisfaction
semistructured interview
Time frame: one week before treatment, 2 weeks during treatment, 1 week after treatment
Adherence rate
Time frame: during 2 weeks treatment
Drop out rate
Time frame: during 2 weeks treatment
Preparation time
Time for preparation of participant in minutes
Time frame: during 2 weeks treatment
Quality of pain
Neuropathic Pain Symptom Inventory (NPSI)
Time frame: one week pre-treatment, one week post-treatment
Pain distribution
size of the drawn area in pixels and percentage in relation to the total body chart indicated by patient into a pain drawing scheme
Time frame: From enrollment to the end of study at 4 weeks
Pain intensity
Numeric Rating Scale (no pain to most imaginable pain)
Time frame: Daily from enrollment to the end of study at 4 weeks
Patient Global Impression of Change (PGIC)
Subjective global impression of change after treatment
Time frame: one week post-treatment
Depression, anxiety and stress
Depression Anxiety \& Stress Scale (DASS)
Time frame: one week pre-treatment and one week post-treatment
Pain chronicity
Mainz Pain Staging System (MPSS)
Time frame: one week pre-treatment
Safety of tDCS
Adverse events questionnaire
Time frame: every day during the 2 weeks treatment
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