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The investigators have shown in incomplete SCI patients that long-term paired associative stimulation is capable of restoring voluntary control over some paralyzed muscles and enhancing motor output in the weak muscles. In this study, the investigators will administer long-term paired associative stimulation to patients with incomplete cervical level SCI and SCI- associated neuropathic pain, and investigate its effectiveness for neuropathic pain treatment.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| PAS | Experimental |
| |
| SHAM | Sham Comparator |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| long-term paired associative stimulation | Device | Paired associative stimulation (PAS) administered 3-5 times per week for 4 weeks to upper limbs. PAS comprises transcranial magnetic stimulation (eXimia magnetic stimulator, Nexstim Ltd, Helsinki, Finland) and peripheral nerve stimulation (given with Dantec Keypoint® electroneuromyography device (Natus Medical Incorporated, Pleasanton, CA, USA)). |
| Measure | Description | Time Frame |
|---|---|---|
| Brief Pain Inventory | 0-10 scale, 0 - no pain, 10 - worst possible pain. | Change from baseline at 1 day after the intervention |
| Brief Pain Inventory | 0-10 scale, 0 - no pain, 10 - worst possible pain. | Change from baseline at 8 weeks after the intervention |
| Numeric Rating Scale | 0-10 scale, 0 - no pain, 10 - worst possible pain. | Change from baseline at 1 day after the intervention |
| Numeric Rating Scale | 0-10 scale, 0 - no pain, 10 - worst possible pain. | Change from baseline at 8 weeks after the intervention |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Helsinki University Hospital | Helsinki | Finland |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 33738876 | Background | Shulga A, Lioumis P, Kirveskari E, Savolainen S, Makela JP. A novel paired associative stimulation protocol with a high-frequency peripheral component: A review on results in spinal cord injury rehabilitation. Eur J Neurosci. 2021 May;53(9):3242-3257. doi: 10.1111/ejn.15191. Epub 2021 Mar 29. | |
| 34019752 | Background |
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| ID | Term |
|---|---|
| D009437 | Neuralgia |
| ID | Term |
|---|---|
| D010523 | Peripheral Nervous System Diseases |
| D009468 | Neuromuscular Diseases |
| D009422 | Nervous System Diseases |
| D010146 | Pain |
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|
| sham long-term paired associative stimulation | Device | Sham transcranial magnetic stimulation and sham peripheral nerve stimulation. |
|
| Vaalto S, Nyman AL, Shulga A. Analgesic effect of paired associative stimulation in a tetraplegic patient with severe drug-resistant neuropathic pain: a case report. Scand J Pain. 2021 May 21;21(4):831-838. doi: 10.1515/sjpain-2021-0012. Print 2021 Oct 26. |
| 41776169 | Derived | Holopainen K, Pohjonen M, Kirveskari E, Vaalto S, Makela JP, Arokoski J, Shulga A. Paired associative stimulation with a high-intensity cortical component and a high-frequency peripheral component in treatment of neuropathic pain after incomplete spinal cord injury - a pilot trial. Spinal Cord Ser Cases. 2026 Mar 4;12(1):3. doi: 10.1038/s41394-026-00729-1. |
| D009461 |
| Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |