Traumatic peripheral nerve injury is a common cause of chronic neuropathic pain, muscle weakness, and functional limitation, particularly in young and active individuals. Current conservative and pharmacological treatments often provide incomplete relief or carry side effects. High-intensity peripheral magnetic stimulation (PMS) is a non-invasive method that may help reduce neuropathic pain and support motor recovery, but evidence in traumatic nerve injury is limited. This randomized, double-blind, sham-controlled trial aims to evaluate whether high-intensity PMS, added to a standardized therapeutic exercise program, improves pain, function, quality of life, and electrophysiological measures in adults with traumatic peripheral nerve injury. Participants will be randomly assigned to receive either active PMS or sham PMS, in addition to the same exercise program. Outcomes will be assessed at baseline, 4 weeks, and 8 weeks.
This is a prospective, randomized, double-blind, sham-controlled clinical trial conducted at a single center. Adults aged 18-65 years with unilateral traumatic peripheral nerve injury confirmed by electromyography, with symptom onset at least 3 months prior, neuropathic pain (DN4 ≥ 4), pain severity (VAS ≥ 4), and reduced muscle strength (MRC \< 5) will be enrolled. Participants will be randomly allocated using computer-generated randomization to one of two groups: (1) active high-intensity PMS plus a standardized therapeutic exercise program, or (2) sham PMS plus the same exercise program. Active stimulation will be delivered using a high-intensity magnetic stimulation system with a predefined neuropathy protocol (approximately 10 minutes per session, variable frequencies 1-60 Hz) applied over the injured peripheral nerve, for a total of 9 sessions over 3 weeks (3 sessions per week). In the sham group, the applicator coil will be reversed to prevent effective delivery of the magnetic field, while device screen and audible feedback are maintained. Both groups will receive an individualized exercise program (active range of motion, strengthening, stretching, proprioception and balance exercises, and occupational therapy) for 20 minutes per day, 5 days per week, over 3 weeks. Participants and outcome assessors will be blinded to group allocation. The physiotherapist delivering the intervention will be aware of allocation but will not participate in assessments. Electrophysiological evaluations will be performed by a blinded electroneurophysiologist. The primary outcome is pain severity measured by the Visual Analog Scale (VAS). Secondary outcomes include the Douleur Neuropathique 4 (DN4) questionnaire, the Brief Pain Inventory (BPI), the Nottingham Health Profile (NHP), Manual Muscle Testing (MRC scale), and electrophysiological parameters including compound muscle action potential (CMAP) amplitude, distal latency, nerve conduction velocity (NCV), and quantitative motor unit potential (MUP) analysis. Assessments will be performed at baseline (week 0), week 4, and week 8. A total of 40 participants (20 per group) is planned based on an a priori sample size calculation.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
40
High-intensity peripheral magnetic stimulation delivered via an inductive coil placed over the injured peripheral nerve, using a predefined neuropathy protocol (approximately 10 minutes per session, variable frequencies 1-60 Hz). Stimulation intensity is increased until motor activity is elicited and kept constant during the session. Applied 3 times per week for 3 weeks (9 sessions total).
Sham peripheral magnetic stimulation using the same device, session duration, and application site, with the applicator coil reversed to prevent effective delivery of the magnetic field to the target tissue. Device screen and audible feedback are maintained to preserve blinding. Applied 3 times per week for 3 weeks (9 sessions total).
Standardized individualized therapeutic exercise program including active range of motion exercises, strengthening exercises, stretching exercises, proprioception and balance exercises, and occupational therapy for activities of daily living. Delivered for 20 minutes per day, 5 days per week, over 3 weeks.
Gaziler Physical Medicine and Rehabilitation Education and Research Hospital
Ankara, Turkey (Türkiye)
RECRUITINGChange in Pain Severity Measured by Visual Analog Scale (VAS)
Pain severity assessed using the Visual Analog Scale (VAS), a 0-10 cm scale where 0 indicates "no pain" and 10 indicates "unbearable pain." Higher scores indicate greater pain severity.
Time frame: Baseline, week 4, and week 8
Change in Neuropathic Pain Assessed by Douleur Neuropathique 4 (DN4)
Neuropathic pain assessed using the Douleur Neuropathique 4 questionnaire, a 10-item instrument based on patient-reported symptoms and clinical examination findings. Scores range from 0 to 10, with a total score of 4 or higher indicating neuropathic pain. Higher scores indicate a worse outcome.
Time frame: Baseline, week 4, and week 8
Change in Pain Severity and Interference Assessed by Brief Pain Inventory (BPI)
Pain severity and pain interference assessed using the Brief Pain Inventory Short Form. Pain severity is scored from 0 to 10 (0 = no pain, 10 = pain as bad as you can imagine) and pain interference is scored from 0 to 10 (0 = does not interfere, 10 = completely interferes) across general activity, mood, walking ability, normal work, relations with other people, sleep, and enjoyment of life. Higher scores indicate a worse outcome.
Time frame: Baseline, week 4, and week 8
Change in Health-Related Quality of Life Assessed by Nottingham Health Profile (NHP)
Health-related quality of life assessed using the Nottingham Health Profile. Each of the six sections (pain, physical mobility, energy level, sleep, social isolation, and emotional reactions) is scored from 0 to 100. Higher scores indicate a worse outcome (greater impairment in quality of life).
Time frame: Baseline, week 4, and week 8
Change in Muscle Strength Assessed by Manual Muscle Testing (MRC Scale)
Muscle strength assessed by manual muscle testing using the Medical Research Council scale in muscle groups innervated by the affected peripheral nerve. Scores range from 0 (no visible contraction) to 5 (full strength against resistance). Higher scores indicate a better outcome.
Time frame: Baseline, week 4, and week 8
Change in Compound Muscle Action Potential (CMAP) Amplitude
CMAP amplitude of the affected nerve measured by nerve conduction studies, reported in millivolts (mV). Higher values indicate better motor nerve function.
Time frame: Baseline, week 4, and week 8
Change in Distal Motor Latency
Distal motor latency of the affected nerve measured by nerve conduction studies, reported in milliseconds (ms). Higher values indicate worse nerve conduction.
Time frame: Baseline, week 4, and week 8
Change in Nerve Conduction Velocity (NCV)
Motor nerve conduction velocity of the affected nerve measured by nerve conduction studies, reported in meters per second (m/s). Higher values indicate better nerve conduction.
Time frame: Baseline, week 4, and week 8
Change in Mean Motor Unit Potential (MUP) Duration
Mean duration of motor unit potentials in the affected muscle, assessed by quantitative needle electromyography and reported in milliseconds (ms). Increased duration indicates chronic reinnervation.
Time frame: Baseline, week 4, and week 8
Change in Mean Motor Unit Potential (MUP) Amplitude
Mean amplitude of motor unit potentials in the affected muscle, assessed by quantitative needle electromyography and reported in microvolts (µV). Increased amplitude indicates chronic reinnervation.
Time frame: Baseline, week 4, and week 8
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